采用长解剖型锁定钢板插入技术内固定治疗同侧股骨干骺端及骨干骨折21例

A report of long anatomic locked plate insertion technique for 21 cases of fractures of ipsilateral metaphyseal and shaft of femur

目的探讨采用长干骺端解剖型锁定钢板插入技术内固定治疗同侧股骨干骺端及骨干骨折的特点及疗效。方法自2007—06--2012—06采用长干骺端解剖型锁定钢板内固定治疗21例同侧股骨干骺端及骨干骨折。其中股骨近端合并股骨干骨折14例，股骨远端合并股骨干骨折7例。术中根据骨折部位选择干骺端切口。在股骨干骺端切口放置长干骺端解剖型锁定钢板，固定好干骺端骨折后，再作有限切口复位股骨干骨折。结果本组均获得随访1～3年，平均1．7年。股骨近端合并股骨干骨折骨愈合时间平均（27．21±7．58）周，股骨远端合并股骨干骨折愈合时间平均（24．71±7．64）周，均无钢板、螺钉断裂。1例开放性股骨远端合并股骨干骨折因感染延迟愈合，出现膝关节强直畸形。14例髋关节功能根据Majeed功能评分标准评定：优9例，平均（89．78±2．73）分；良3例，平均（79．00±4．36）分；可2例，平均（63．00±1．41）分。7例膝关节功能按Kolmert标准评定：优4例，良2例，可1例。结论采用较长的解剖型锁定钢板作为内固定材料手术治疗同侧股骨干骺端及骨干骨折是较好的选择。其特点有：①用1种内固定材料固定2个部位骨折，不剥离骨膜，有利于骨折愈合；②锁定螺钉固定后，成为一种角度固定的钢板，集合了钢板内固定和外固定架的优点；③采用有限切口可减少创伤、降低出血量、缩短住院时间。

Objective To report a situation of the surgical treatment using insertion technique of long-metaphyseal anatomy locking plate for 21 patients with ipsilateral metaphysis and femoral shaft fractures. Methods From June 2007 to June 2012, 21 patients with ipsilateral metaphysis and femoral shaft fractures（14 patients with ipsilateral proximal femur and femoral shaft fractures,7 patients with ipsilateral distal femur and femoral shaft fractures） were operated using insertion technique of long- metaphyseal anatomy locking plate. According to the fracture site, the metaphyseal incision was selected. Long metaphyseal anatomical locking plate was used to fLX metaphysis fracture, which was inserted and placed from the incision of femoral metaphysic. Then the fracture of femoral shaft was reduced with limit incision in the site of fracture of femoral shaft. Results All patients were followed up, the duration of follow-up was 1 to 3 years （average 1.7 years）. Bone healing time of the ipsilateral proximal femur and femoral shaft fractures were （27.21＋7.58）weeks, and of the ipsilateral distal femur and femoral shaft fractures were （24.71±7.64）weeks. No plate breakage occurred. The delayed union of 1 case of open distal femur and femoral shaft fractures occurred due to infection, and that stiffness and deformity of knee appeared. According to the Majeed hip function score, there were 9 excellent （89.78±2.73）, 3 good （79.00±4.36）, and 2 fair （63.00±1.41）. According to Kolmert I standard assessment of knee joint function, there were 4 excellent, 2 good and 1 fair. Conclusion Using a longer of anatomic locking plate as f＇Lxation surgery for ipsilateral femur metaphysis and shaft fractures is a better choice. Its characteristic is （1） that not stripping periosteal is conducive to the healing of fractures through fLxing fractures in two part of femur with a fLxation; （2） that locking screws of the plate were a fLxed angle within the fixed plate, which is a collection of the advantages of plate fixation and external fixation; （3）that applications of limited incision can also reduce the trauma, reduce the amount of bleeding in operation, and get shorter hospital stays.