锁定钢板加对侧异体骨板固定治疗陈旧性股骨干粉碎性骨折

Treatment of old comminuted fractures of the femoral diaphysis by locked plate and contralateral allograft bone plate

目的 ：探讨使用钢板加对侧异体骨板固定治疗陈旧性股骨干粉碎性骨折的疗效。方法 ：自2008年1月至2010年2月,采用钢板加对侧异体骨板固定治疗11例陈旧性股骨干粉碎性骨折患者,男7例,女4例;年龄为25-53岁,平均36.4岁。开放性骨折4例,闭合性骨折7例;其中开放性骨折均为GustiloⅠ型;骨折按照Winquist分型：Ⅱ型2例,Ⅲ型8例,Ⅳ型1例。通过X线检查观察术后患者骨折愈合时间,并采用膝关节HSS评分标准对术后1年膝关节功能恢复情况进行评价。结果：11例患者均获得随访,时间1-5年,平均30个月。无钢板断裂、脂肪栓塞、骨折延迟愈合及不愈合、旋转畸形及明显的短缩畸形,没有严重的免疫排斥反应等并发症。11例患者术后均达到骨性愈合,平均愈合时间5.9个月（4-9个月）。术后1年膝关节活动度：屈曲100°-125°,平均117°;伸直-5°-5°,平均2.1°;HSS评分为83.73±9.82。结论：应用钢板加对侧异体骨板固定治疗陈旧性股骨干粉碎性骨折具有治愈率高、并发症少、术后功能恢复良好、术后患侧股骨更加牢固的特点,此种方法能够提高骨折稳定性及促进骨痂生长,增加骨的强度。

Objective：To investigate the clinical effects of steel plate and contralateral xenogenic bony plate for the treatment of old fracture of the femoral diaphysis.Methods：From January 2008 to February 2010,11 patients with old fracture of the femoral diaphysis were treated with femoral plate and contralateral xenogenic bony plate,including 7 males and 4females with an average age of 36.4 years old ranging from 25 to 53 years old;4 cases were open fractures and 7 were closed fractures.All open fractures were Gustilo type Ⅰ.According to Winquist classification,there were 2 cases of type Ⅱ,8 of typeⅢ,1 of type Ⅳ.The evaluation of fracture healing time were determined by X-ray.The clinical outcomes at 1 year after treatment were evaluated by HSS assessment.Results：All patients were followed up from 1 to 5 years with an average of 30 months.There were no complications such as internal fixation breakage,fat embolism,fracture delayed union and ununited,rotational deformity and shortening,severe immune rejection occurred.All fractures were bone healed,the time of union averaged 5.9 months ranging from 4 to 9 months.At 1 year after operation,the motion of knee joint was 117° on average（100°to125°） of flexion,2.1° on average（-5°to 5°） of unbend.According to the criterion of HSS,the result was 83.73±9.82 at 1 year after surgery.Conclusion：Locked plate and xenogenic bony plate for the treatment of old fracture of femoral diaphysis has advantages of high curative rate and low complications,good postoperative function recovery,it is a reliable treatment to elevate the stability of fixation and promote the osteogenesis.