闭合复位髓内钉内固定治疗复杂股骨粉碎骨折的效果观察

Observation of effect by closed reduction intramedullary nail internal fixation in the treatment of complex comminuted femoral fracture

目的观察在复杂股骨粉碎骨折治疗中采用闭合复位髓内钉内固定的临床治疗效果。方法 19例复杂股骨粉碎骨折患者以A0分型为依据,8例C1型,4例C2型,7例C3型,患者均采用闭合复位髓内钉内固定方法进行治疗,其中15例从股骨大粗隆顺行将髓内钉插入进行固定治疗,而4例患者从膝关节处逆行将髓内钉插入进行固定治疗,观察治疗效果。结果 19例患者最长随访时间3.0年,最短1.5年,平均随访时间(2.1±0.3)年。所有患者骨折均得以愈合,没有出现骨不连及断钉等并发症,最长愈合时间7个月,最短4个月,平均愈合时间(4.5±0.9)个月;最长手术时间125min,最短60min,平均手术时间(91.5±11.6)min;最大术中出血量600 ml,最少150 ml,平均术中出血量(298.5±100.8)ml。经过治疗,膝关节功能为优16例(84.21%)、良3例(15.79%)、无一例为差,膝关节功能优良率为100.00%,所有患者均可正常生活和工作。结论在复杂股骨粉碎骨折治疗中采用闭合复位髓内钉内固定方法效果确切,在有骨科牵引装置和术中透视条件的医院可应用和推广。

Objective To observe clinical curative effect by closed reduction intramedullary nail internal fixation applied in the treatment of complex comminuted femoral fracture. Methods A total of 19 patients with complex comminuted femoral fracture were divided by AO classification into 8 Cases with C1 type, 4 cases with C2 type and 7 cases with C3 type. All patients received closed reduction intramedullary nail internal fixation for treatment. 15 cases among them received intramedullary nail by prograde motion from femoral trochanter for fixation treatment, and the other 4 cases received retrograde motion from knee joint for fixation treatment. Their curative effects were observed. Results The 19 cases had the longest follow-up time as 3.0 years and the shortest as 1.5 years, along with mean follow-up time as （2.1 ± 0.3） months. All patients had healed fracture without complications of ununion and broken nail. They had the longest healing time as 7 months and the shortest as 4 months, along with mean healing time as （4.5 ± 0.9） months. The longest operation time was 125 min and the shortest was 60 min, with mean operation time as （91.5± 11.6） min. The highest intraoperative bleeding volume was 600 ml and the lowest was 150 ml, with mean intraoperative bleeding volume as （298.5 ± 100.8） ml. After treatment, there were 16 cases with excellent knee joint function （84.21%）, 3 cases with good function （15.79%） and none with bad function, with good rate of knee joint function as 100.00%. All patients regained normal life and work. Conclusion Implement of closed reduction intramedullary nail internal fixation provides precise effect in treating complex comminuted femoral fracture. This method can be applied and promoted in hospitals with orthopedic traction and intraoperative fluoroscopy devices.