双锁定接骨板治疗股骨远端复杂性骨折

Dual locking plate for complex distal femoral fracture

目的回顾分析双锁定接骨板治疗股骨远端复杂性骨折患者的临床资料,评价其治疗效果。方法 2008年7月至2011年8月,股骨远端髁上、髁间粉碎性骨折23例,运用外侧锁定加压接骨板结合内侧重建锁定接骨板治疗,术后加强早期膝关节功能锻炼。结果手术时间78～213min,平均115min;术中出血78～526mL,平均237mL;术后伤口2例表浅感染,不影响骨愈合;所有病例获随访12～27个月,平均18.5个月;术后骨愈合4～12个月,平均6.8个月。2例存在前后成角3°～7°,1例短缩1cm,未作特殊处理,无下肢内外旋、接骨板螺钉松动断裂、骨不连、膝内外翻畸形等并发症。术后膝关节功能Merchant评分优15例,良6例,可2例,优良率91.3%。结论对于股骨远端复杂性骨折,运用外侧锁定加压接骨板结合内侧重建锁定接骨板固定,骨折断端充分植骨是一种比较理想的治疗方法。

Objective To review and analyze clinical data of dual-locking plate for complex distal femoral fractures,to evaluate the therapeutic effect. Methods From July 2008 to August 2011,their were 23 patients of distal femoral fractures. There were su- pracondylar fracture and intercondylar comminuted fracture. Lateral locking compression plate combined with medial reconstruction locking plate were used for distal femoral fractures. After surgery,knee joint training was enhanced early after operation. Results Operative time was 78--213 min,an average of 115 min. Blood loss was 78--526 mL,an average of 237 mL. 2 cases suffered postop- erative superficial wound infection,but it did not affect bone healing. All cases were followed up for 12 to 27 months,an average of 18.5 months. Postoperative bone healing time was 4. to 12 months,an average of 6.8 months. Two cases had a sagittal plane angle of 3°- 7°,and 1 case had leg shortening of 1 cm, no special treatment was necessary for them. There were not any lower limb exter- nal rotation,or plate screw loosening or breakage,nonunion,or knee varus. Merchant ratings for postoperative knee function were performed,it was excellent in 15 cases,good in 6 cases,mild in 2 cases, 91.3 % of the patients were in excellent or good condition. Conclusion For the complex distal femur fractures, it was good to use lateral locking compression plate combined with the medial reconstruction locking plate for internal fixation,full graft between fracture stumps was helpful for heal of fracture.