微创内固定系统和髁支持钢板治疗成人股骨远端C型骨折的病例对照研究

Comparative study of less invasive stabilization system(LISS) and the condylar support plates for the treatment of AO type C distal femoral fractures in adults

目的 ：总结应用微创内固定系统与股骨髁支持钢板治疗股骨远端C型骨折的并发症和早期临床效果。方法：对2007年9月至2012年2月进行手术治疗并获得随访的46例股骨远端C型骨折患者进行回顾性分析,其中25例行微创内固定系统固定,男14例,女11例,年龄（56.3±4.2）岁,C1型14例,C2型8例,C3型3例,住院时间（15.6±1.7）d;21例行股骨髁支持钢板内固定,男12例,女9例,年龄（53.8±5.1）岁,C1型13例,C2型6例,C3型2例,平均住院时间（17.8±2.2）d。从手术相关指标、术后并发症情况及患侧膝关节功能评分3个方面对两种治疗方法进行比较分析。结果：46例患者均获随访,时间13-38个月,平均19.6个月。1例感染,3例内固定松动,1例骨折不愈合,1例患膝关节活动受限。两组患者切口长度、术中出血量、骨折愈合时间比较差异有统计学意义（P〈0.05）,而手术时间、住院时间比较差异无统计学意义（P〉0.05）。术后并发症的发生率比较差异无统计学意义（P〉0.05）,末次随访的Evanich评分比较差异有统计学意义（P〈0.05）。结论 ：微创内固定系统治疗股骨远端C型骨折具有创伤小、骨折愈合快及功能恢复好等特点,是治疗股骨远端C型骨折的理想内固定之一。

Objective：To summarize the complications and the early clinical effect of less invasive stabilization system and the femoral condylar support plates in the treatment of AO type C distal femoral fractures. Methods：From September 2007 to February 2012,46 patients with AO type C distal femoral fractures were retrospectively studied. Of all patients 25 were treated with less invasive stabilization system including 14 males and 11 females with a mean age of（56.3±4.2） years old; according to AO classification,there were 14 cases of C1,8 cases of C2 and 3 cases of C3 with a mean hospital stay of（15.6±1.7）days. While 21 cases were treated with femoral condylar support plates fixation including 12 males and 9 females with a mean age of（53.8±5.1） years old;there were 13 cases of C1,6 cases of C2 and 2 cases of C3 with a mean hospital stay of（17.8±2.2）days. Comparative analysis was performed from the operation related index,postoperative complications and Evanich score of the knee joint function between the two groups at follow up. Results：All 46 patients were followed up from 13 to 38 months with a mean time of 19.6 months after surgery. Complications included 1 case with infection,3 cases with internal fixation failure,1 case with nonunion and 1 case with activity limitation of the affected knee. The differences in the incision length,blood loss,fracture healing time were significant between two groups（P〈0.05）,while there was no significant difference in the duration of operations,hospital stays and the incidence of postoperative complications between two groups（P〈0.05）. The statistical significance was also found in the Evanich score at last follow up between two groups（P〉0.05）. Conclusion：Patients with less invasive stabilization system fixation had the characteristics of less trauma,shorter fracture healing time and better functional recovery. Less invasive stabilization system had became one of the ideal internal fixations in the treatment of AO type C distal femoral fractures.