前正中纵行切口双钢板固定治疗C3型股骨远端骨折

Treatment of type C3 distal femoral fractures with double plating fixation via anteriormiddle approach

目的:探讨前正中纵行切口双钢板固定治疗C3型股骨远端骨折的临床疗效和可行性。方法:自2008年8月至2011年8月,收治C3型股骨远端骨折12例,男8例,女4例;年龄25～55岁,平均40岁;车祸伤9例,高处坠落伤3例;左侧7例,右侧5例;开放性骨折5例,闭合性骨折7例。受伤至入院时间20min～5d。入院给予胫骨骨牵引5～8d后行前正中纵行切口双钢板内固定术,伴骨缺损者给予自体或异体骨植骨治疗。末次随访时按Merchan评分标准进行评估。结果:手术时间110～160min,平均135min;术中出血量300～500ml,平均400ml。术后伤口均Ⅰ期愈合。患者均获随访,时间1～36个月,平均24个月。所有患者复位满意,无术后感染、骨不连、深静脉血栓形成等并发症。骨折愈合时间18～24周,平均21周。末次随访时按Merchan评分标准评估:优4例,良6例,可1例,差1例。结论:前正中纵行切口双钢板固定是治疗C3型股骨远端骨折的有效方法之一,具有术野显露清晰、手术操作简便、骨折解剖复位及固定牢靠等优点,但应严格掌握手术指征及操作规程。

Objective： To investigate clinical efficacy and feasibility of double-plating fixation via anteriormiddle approach in treating type C3 distal femoral fractures. Methods：From August 2008 to August 2011,12 cases with type C3 distal femoral fractures were treated,including 5 open fractures and 7 closed fractures. Among them,there were 8 males,4 females with an average of 40 years （ranged,25 to 55 years）. There were 7 in left side, 5 in right side. Nine cases were caused by car acci- dent, 3 cases by falling down. The duration from injury to hospital was form 20 minutes to 5 days （mean 135 min）. After tibia bone traction for 5 to 8 days, the operation were performed by double-plating fixation via anteriormiddle approach, and autograft of iliac bone or allograft bone grafting were given to bone defect. Knee joint function was evaluated according to Merchanetal criteria. Results：The operation time was from 110 to 160 min,with an average of 135 min,the blood loss was from 300 ml to 500 ml,with an average of 400 ml. Post-operative wound were stage 1[ healing. All patients were followed up from 16 to 36 months （ mean 24 months）. No infection,reduction loss, nonunion, deep vein thrombosis occurred. Bone healing time was for 18 to 24 weeks with an average of 21 weeks. According to the Merchanetal criteria, 4 cases got excellent results, 6 good, 1 fair and 1 poor. Conclusion： Double-plating fixation via anteriormiddle approach for type C3 distal femoral fractures is an effective way, which has advantages of obvious exposure, simple manipulation, anatomical reduction, stable fixation. However, operation indications and operating instructions should be strictly followed.