逆行交锁髓内钉内固定治疗股骨髁上及髁间骨折43例

The retrograde intramedullary nail treating supracondylar and intracondylar fractures in 43 cases

目的 对应用GSH逆行交锁髓内钉固定治疗的 43例股骨髁上和髁间骨折的病例进行回顾性研究。 方法 1997年 1月～ 1999年 2月 ,通过切开复位、逆行交锁髓内钉内固定治疗股骨髁间和髁上骨折 43例。其中男 30例 ,女 13例 ;年龄 18～ 76岁 ,平均 35岁 ;股骨髁上骨折 2 9例 ,髁间骨折 14例。采用AO分类法 ,其中A型骨折 2 9例 ,B型 6例 ,C型 8例。随访时间 3个月～2年 ,平均 6个月。 结果 骨折平均愈合时间 14周。根据Neer膝关节功能评分标准 ,优≥ 86分 ,良≥ 72分 ,可≥ 5 6分 ,差 <5 6分。结果 :优 2 2例 ,良 12例 ,优良率 79.0 7% ;可 6例 (13.95 % ) ;差 3例 (6 .98% )。 结论 采用GSH逆行交锁髓内钉系统是治疗股骨髁上及髁间骨折的理想方法。多数患者可通过早期膝关节功能训练达到理想的功能效果。采用切开复位内固定 ,可扩大逆行交锁髓内钉的适应证。但对B型或C型骨折术后功能训练的时机和方法 ,有待进一步探讨。

Objective To retrospectively report 43 cases of femoral supracondylar and intracondylar fractures treated by retrograde intramedullary nail. Methods From January 1997 to February 1999, 43 cases (30 males,13 females) of supracondylar and intracondylar fractures were treated with retrograde intramedullary nail, of which 29 fractures were due to the femoral supracondylar fracture, 14 to the femoral intramedullary fracture. AO classification system was used for all the cases, fracture type A in 29 cases, type B in 6 cases, type C in 8 cases. The follow up period was ranging from 3 months to 2 years. Results The average time of bone healing was 14 weeks. The functional scores: 22 excellent (≥86 scores) and 12 good (≥72), with an excellence rate of 79.07%; 6 fair (≥56) accounting for 13.95 %, 3 bad (<56) accounting for 6.98% . Conclusions It is a good way with retrograde intramedullary nail to treat the femoral supracondylar and intracondylar fractures. Early CPM exercise is in favor of the functional recovery of the knee for the most cases. The open reduction and fixation can expand the indications of retrograde intramedullary fractures. However, how and when the rehabilitation should be performed in type B and type C fracture needs further studying.