新型股骨远端前外侧入路治疗股骨远端骨折疗效观察

NEW ANTEROLATERAL APPROACH OF DISTAL FEMUR FOR TREATMENT OF DISTAL FEMORAL FRACTURES

目的与常规入路比较,探讨新型股骨远端前外侧入路治疗股骨远端骨折的疗效。方法2007年7月-2009年12月,58例接受切开复位内固定术且符合选择标准的股骨远端骨折患者纳入研究。其中28例采用新型股骨远端前外侧入路,沿大腿外侧弧形向前、向上至股四头肌扩张部,延伸至髌骨外侧达胫骨结节作切口（新型入路组）,30例采用常规股骨远端外侧或前外侧入路（常规入路组）。两组患者性别、年龄、致伤原因、侧别、骨折类型、合并症、受伤至手术时间及术前处理方法比较,差异均无统计学意义（P〉0.05）,具有可比性。记录两组患者手术时间、术中出血量、术中透视次数、住院时间及膝关节功能美国特种外科医院（HSS）评分。结果两组患者均顺利完成手术,术中无血管、神经损伤发生;术后切口均Ⅰ期愈合。新型入路组手术时间、术中透视次数显著少于常规入路组,差异有统计学意义（P〈0.05）;两组术中出血量及住院时间比较,差异均无统计学意义（P〉0.05）。患者均获随访,随访时间12～36个月,平均19.8个月。X线片复查示,两组患者骨折均愈合,新型入路组骨折愈合时间为（12.62±2.34）周,常规入路组为（13.78±1.94）周,比较差异无统计学意义（t=2.78,P=0.10）。末次随访时,新型入路组膝关节HSS评分为（94.4±4.2）分,显著优于常规入路组（89.2±6.0）分（t=3.85,P=0.00）。结论与常规入路比较,采用新型股骨远端前外侧入路行切开复位内固定术中治疗股骨远端骨折,对软组织损伤小,骨折显露更充分,允许膝关节术后早期功能锻炼,促进膝关节功能恢复。

Objective To assess the effectiveness of the new anterolateral approach of the distal femur for the treatment of distal femoral fractures. Methods Between July 2007 and December 2009, 58 patients with distal femoral fractures were treated by new anterolateral approach of the distal femur in 28 patients （new approach group） and by conventional approach in 30 patients （conventional approach group）. There was no significant difference in gender, age, cause of injury, affected side, type of fracture, disease duration, complication, or preoperative intervention （P 〉 0.05）. The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, hospitalization days, and Hospital for Special Surgery （HSS） score of knee were recorded. Results Operation was successfully completed in all patients of 2 groups, and healing of incision by first intention was obtained; no vascular and nerves injuries occurred. The operation time and intraoperative fluoroscopy frequency of new approach group were significantly less than those of conventional approach group （P 〈 0.05）. But the intraoperative blood loss and the hospitalization days showed no significant difference between 2 groups （P 〉 0.05）. All patients were followed up 12-36 months （mean, 19.8 months）. Bone union was shown on X-ray films; the fracture healing time was （12.62 ＋ 2.34） weeks in the new approach group and was （13.78± 1.94） weeks in the conventional approach group, showing no significant difference （t=2.78, P=0.10）. The knee HSS score at last follow-up was 94.4 ± 4.2 in the new approach group, and was 89.2 ± 6.0 in the conventional approach group, showing significant difference between 2 groups （t=3.85, P=0.00）. Conclusion New anterolateral approach of the distal femur for distal femoral fractures has the advantages of exposure plenitude, minimal tissue trauma, and early function rehabilitation training so as to enhance the function recovery of knee joint.