前正中切口联合微创内固定系统双钢板固定C3型股骨远端骨折的疗效分析

Efficacy of less invasive stabilization system fixation and double plating with anterior midline incision in treatment of AO-type C3 distal femoral fractures

目的探讨前正中切口联合微创内固定系统(less invasive stabilization systems,LISS)双钢板固定AO-C3型股骨远端骨折的临床疗效。方法筛选2014年6月至2017年3月我科采用膝关节置换术中常用的前正中切口联合LISS双钢板固定治疗AO-C3型股骨远端骨折的患者18例,其中男性12例,女性6例,年龄19~62岁。包括交通伤11例,高坠伤7例;6例为开放性骨折,12例为闭合性骨折。最后1次随访中采用Kolment和Wulff(1982)治疗评价标准评定内固定术后膝关节功能。结果18例患者手术时间平均145(110~200)min,术后均获得17.5(12~25)个月随访,术后骨折平均愈合时间22(20~26)周,骨折全部愈合,未出现骨折不愈合、感染、骨髓炎及神经血管损伤等并发症。对末次随访患者按照Kolment和Wulff(1982)治疗评价标准进行评估:优6例,良9例,可2例,差1例,优良率达83.33%。结论采用的膝关节前正中切口可充分暴露股骨远端关节面,术中显露清晰,便于关节面骨折的解剖复位,可一期处理关节内结构损伤,同时联合LISS双钢板牢固固定骨折,避免对骨折断段软组织的过多剥离,允许术后即刻进行有效的早期功能锻炼,可以取得良好的疗效。

Objective To evaluate the efficacy of less invasive stabilization systems （LISS） fixation and double plating on the treatment of AO-type C3 distal femoral fractures via anterior midline approach. Methods From June 2014 to March 2017, 18 cases of AO-type C3 distal femoral fractures treated in our department were recruited in this study. They were 12 males and 6 females, at a mean age of 19 -62 years. There were 11 cases due to traffic accidents and 7 due to falls from heights. Six of them had open fractures and 12 had closed fractures. They all were treated with LISS fixation and double plating with anterior midline incision. Kolment and Wulff criteria were used to evaluate knee joint function after internal fixation at the last time of follow-up. Results For all the subjects, the average operative tittle was 145 （ 110 to 200） rain, and they were followed up for 17.5 （ 12 to 25 ） months. They all achieved primary wound healing, and had an average time of 22 （20 to 26） weeks for fracture healing. No nonunion, infection, osteomyelitis or injuries of nerves and arteries were observed. According to the results of Kolment and Wulff criteria for knee joint function evaluation, 6 of them got excellent, 9 good, 2 fair and 1 poor outcomes, with a rate of 83.33% for good and excellent outcomes. Conclusion The treatment of type C3 distal femoral fractures via anterior middle approach of knee joint can fully reveal the articular surface of the femoral condyle. And the operative vision is clear, making it easy for anatomical reduction of articular surface fractures. Combined with LISSdouble locking plates fixation treatment, it can avoid the injury of soft tissue, and the fracture also be rigid fixation. Postoperative early functional exercise should be allowed to obtain good clinical results.