有限切开手术治疗股骨远端骨折的临床研究

The Clinical Research of the treatment of distal femoral fractures through mini-open approach

目的:探讨有限切开锁定钢板,逆行髓内钉,动力髁螺钉(DCS)内固定治疗股骨远端骨折的疗效。方法:2002年1月-2010年10月,采用手术治疗股骨远端骨折96例,其中,男68例,女28例,年龄22～68岁,平均38.8±2岁。致伤原因车祸52例,坠落伤36例,撞砸伤8例,根据A0/ASIF分类系统进行分类:A1型36例,A2型22例,A3型14例,C型24例;受伤至手术时间3～9d,平均5d±1d分别采取有限切开股骨髁解剖锁定钢板治疗40例,有限切开逆行髓内钉治疗32例,有限切开动力髁螺钉(DCS)治疗24例。结果:96例均获随访,随访时间10～30个月(平均18个月),无术后内固定折裂感染,膝关节功能评价采用1ysholm评分系统,对手术时间、出血量、骨折愈合情况,术后并发症等指标进行评价。膝关节功能:锁定钢板组优良率为90.00%;与髓内钉组(优良率为75.00%)、动力髁组(优良率为74.90%)比较差异有统计学意义P<0.05。手术时间、出血量、骨折愈合情况,术后并发症指标锁定钢板组与髓内钉组、动力髁组比较差异有统计学意义P<0.05。髓内钉组,动力髁组相关数据比较,差异无统计学意义P>0.05,结论:有限切开锁定钢板,逆行髓内钉,动力髁是治疗股骨远端骨折的有效手术方法,锁定钢板的疗效,手术时间、出血量、骨折愈合,术后并发症等方面优于逆行髓内钉,动力髁,是治疗股骨远端骨折的理想方法。

Objective： To explore clinical effect of distal femoral fractures treated with locking plates, retrograde intramedul- lary nailing and DCS . Methods：From January 2002 to October 2010, 96 patients （68 males and 28 females） with distal femoral fractures were treated with surgical reduction and internal fixation through mini-open approach. The mean age of the patients was 38.8±2 years （range, 22 to 68 years）. According to AO/ASIF classification, 36 cases were type A1, 22 cases were type A2 , 14 cases were type A3 and 24 cases were type C. 40 cases were treated with locking plate, 32 cases were treated with retrograde intramedullary nailing and 24 cases were treated with DCS. Results： The average duration of follow-up was 18 months （range, 10 to 30 months） for 96 patients. There were no cases of knee joint infections . According to the lysholm knee score, the excellent rate was 90.00 % in locking plate group, the excellent rate was 75.00 % in retrograde intramedullary nailing group and 74.90 % in DCS group. The difference has statistically significance for the loc- king plate group with the other two groups （P〈 0. 05）. The retrograde intramedullary nailing group has no significant difference with DCS group （P〉0.05）. Conclusion：The three ways of locking plate, retrograde intramedullary nailing and DCS are the effective methods to treat distal femoral fracture. The locking plate is better than the other two methods in op- erative time, efficacy, blood loss and complication. It is an ideal method to treat distal femoral fractures.