内后侧入路对侧微创内固定系统钢板治疗单纯股骨内髁骨折

Fractures of femoral medial condyle treated with contralateral less invasive stabilization system through a medial-posterior approach

目的探讨内后侧入路对侧微创内固定系统（LISS）钢板治疗单纯股骨内髁骨折的方法及临床疗效。方法回顾性分析2010年12月至2014年12月期间采用手术治疗的14例单纯股骨内髁骨折患者资料。男10例，女4例；年龄为33～64岁，平均44．6岁。骨折AO分型：33-B2型10例，33．B3型4例。致伤原因：交通伤7例，坠落伤6例，重物砸伤1例。受伤至手术时间为3～10d，平均5．4d。所有患者均采用膝关节内后侧入路对侧LISS钢板或加T型支撑钢板内固定。结果14例患者术后获平均18个月（12～24个月）随访。所有患者骨折均获骨性愈合，愈合时间为3～5个月，平均3．5个月。随访期间无一例患者发生关节面塌陷、关节僵硬、关节内感染、骨不连及畸形愈合等并发症。末次随访时采用Schatzker—Lambert股骨远端骨折功能评分标准评定患膝功能：优9例，良3例，可1例，差1例。结论内后侧入路对侧LISS钢板治疗单纯股骨内髁骨折支撑性强，固定强度高，有利于患者早期进行功能锻炼，术后临床疗效满意。

Objective To investigate the therapeutic efficacy of contralateral less invasive stabilization system （LISS） through a medial-posterior approach for fractures of femoral medial condyle. Methods From December 2010 to December 2014, 14 patients with fracture of femoral medial condyle were treated surgically at our department, They were 10 males and 4 females, aged from 33 to 64 years （average, 44. 6 years）. By AO classification, 10 cases were type 33-B2 and 4 cases type 33-B3. Causes of injury included traffic accident in 7 cases, falling in 6 and heavy object crush in one. Internals from injury to operation ranged from 3 to 10 days （average, 5.4 days） . All the patients were treated by open reduction and internal fixation with contralateral LISS plate or T plate through a knee medial posterior approach. Results The 14 patients were followed up for 12 to 24 months （average, 18 months）. All fractures got bony healing after 3 to 5 months （average, 3.5 months）. No collapse of joint surface, joint stiffness, joint infection, malunion or nonunion occurred. According to the Schatzker-Lambert criteria for functional recovery of the distal femoral fractures, the function of the affected knee was assessed at the last follow-up as excellent in 9 cases, good in 3, fair in one and poor in one. Conclusion Open reduction and internal fixation with contralateral LISS plate through a medial-posterior approach is effective for fractures of femoral medial condyle due to its strong buttress, rigid fixation, advantage for early functional exercise, and satisfactory therapeutic outcome.