Fraser型漂浮膝:Ⅰ型与Ⅱb型疗效比较

Comparison of efficacy between Fraser type Ⅰand type Ⅱb floating knee injury

目的探讨手术治疗Ⅰ型与Ⅱb型浮膝损伤术后膝关节功能疗效比较。方法回顾性研究2009年1月-2013年12月收治的50例浮漆损伤患者,男性35例,女性15例;年龄18-56岁,平均（38.5±2.5）岁。其中道路交通伤20例,高处坠落伤12例,压砸伤18例。合并腹部脏器伤7例,胸部损伤10例;颅脑损伤5例及其它部位骨折15例,前交叉韧带损伤3例,半月板损伤5例。其中左侧38例、右侧12例。FraserⅠ型组30例、Ⅱb型组20例,采用Karlstrom和Olerud标准进行功能评价。结果 50例平均随访（20.5±1.5）个月,骨折愈合时间6-18个月。Ⅰ型组与Ⅱb型组的功能评价优良率分别为86.6%和75.0%,两组差异有统计学意义（P〈0.05）。结论Ⅰ型组采用交锁髓内钉固定,Ⅱb型组股骨侧采用接骨板,胫骨侧采用交锁髓内钉配合术后早期功能锻炼,Ⅰ型疗效优于Ⅱb型。

Objective To explore the clinical efficacy of Fraser typeⅠ and typeⅡb floating knee injury after surgical treatment. Methods A retrospective study was conducted in 50 cases of floating knee injury of orthopedic trauma center in Hebei Province（ Tangshan Second Hospital） from Jan. 2009 to Dec. 2013. Among them,35 were males and 15 were females with an average age of（ 38. 5 ± 2. 5） years（ 1-56 years）. Twenty cases were resulted from vehicle accidents,12 from falls and 18 from crush. Seven cases were accompanied with abdominal organ injury,10 cases with chest injury,5 with brain injury,15 with injuries in other sites,3 with anterior cruciate ligament injury and 5 with meniscus injury. Thirty cases were classified as Fraser type I and 20 cases as type Ⅱ b. Karlstrom-Olerud criteria was employed for functional evaluation. Results Fifty cases were followed up with an average of（ 20. 5 ± 1. 5） months and the healing time was 6 to 18 months. Excellent and good rate was 86. 6% and 75. 0%respectively in type I and typeⅡ b group and the difference was statistically significant（ P〈0. 05）. Conclusion Interlocking intramedullary nailing is employed in type I group; bone plate is employed in typeⅡ b group,interlocking intramedullary nailing combined with early rehabilitation exercise is employed in tibia. Efficacy in type I group is better than typeⅡ b group.