股骨髁上或髁间粉碎骨折交锁髓内钉固定

Interlocking intramedullary nailing for supracondylar and intercondylar fractures of the distal part of the femur

目的：研究分析应用交锁髓内钉治疗股骨髁上或髁间骨折的指征、方法、疗效及应用中的注意问题。方法：随访本科１１ 年间用交锁髓内钉固定股骨髁上或髁间骨折的３５ 例患者，对患者的一般情况、术后并发症及功能恢复等作分析研究。结果：３５ 例股骨远端髁上或髁间骨折患者，关节外骨折２９例，关节内骨折６ 例。３１ 例得到随访（平均２７ 个月），骨折均愈合。无术后肺炎、深静脉栓塞等严重并发症。采用改良膝关节功能评分，１２ 例（３８．７％ ）为优，１５ 例为良（４８．４％ ），４ 例为可（１２．９％ ），优良率为８７．１％ 。结论：股骨远端髁上或髁间粉碎骨折作交锁髓内钉固定，关节面解剖对位良好，固定牢固确实，术后即能早期功能锻炼，随访期内未见创伤性骨关节炎的发生，疗效满意。

Objective:To review the results and complications of the interlocking nail to the supracondylar and intercondylar fractures of the distal part of the femur, and piont out some problems of its application. Methods: The demographic, complications and healing of the patients of 11 years in our hospital were studied. Results: Thirty one of 35 cases were followed up for an average of 27 months. There were 29 extra articular(type A) fractures and 6 intra articular (type C1 and type C2) fractures. Patients who had an isolated condylar fracture or a severely comminuted intercondylar fractures were treated with other types of implants or methods. Postoperatively, early mobilization exercise and weight bearing were carried out. The results correlated with the age of the patient and the presence of an intra articular fracture. Conclusion: The distal part fractures of the femur treated with the interlocking nail are excellent in the maintainance of the articular surface anatomically. The patients should exercise early, which is very useful to avoid the truma osteoarthritise. The nail should be correctly selected to avoid the broken of the nail, infection and malunion.