器械辅助复位联合带锁髓内钉内固定术治疗复杂股骨干多段骨折

Treatment of multi-segment fracture of complex femoral shaft with instrument-assisted reduction combined with intramedullary interlocking nail fixation

目的:探讨复杂股骨干多段骨折实施微创小切口、器械辅助复位联合带锁髓内钉固定术的手术疗效。方法:2013年1月至2016年1月采用器械辅助复位联合带锁髓内钉内固定术治疗32例股骨干多段骨折患者,男22例,女10例;年龄17~68岁,平均45岁;受伤距手术时间5~10 d,平均7 d;入院后视情况常规行胫骨结节或股骨髁上骨牵引术,对患者全身情况进行评估,术中记录手术时间、术中出血量。依据Thorsen股骨骨折术后形态评估标准及Hohl膝关节功能评价标准对术后疗效进行评价,观察术后骨折愈合、并发症发生及患肢功能恢复情况。结果:所有病例获得随访,时间6~24个月,平均12个月;手术时间48~76 min,平均67 min;术中出血量150~400 ml,平均220 ml;手术切口均达甲级愈合,骨折均达临床愈合标准,骨折愈合时间4.2~10.8个月,平均5.7个月;无骨不连、切口感染及内固定断裂、失效等并发症发生;依据Thorsen股骨骨折术后形态评估标准:优28例,良3例,可1例;依据Hohl膝关节功能评价标准:优30例,良2例。结论:器械辅助复位联合带锁髓内钉内固定术治疗复杂股骨干多段骨折,具有创伤小、固定可靠、恢复快、术后可早期行功能锻炼等优点,符合BO固定原则,是治疗股骨多段骨折的一种有效方法。

Objective：To investigate the effect of minimally invasive mini-incision and instrumented reduction combined with interlocking intramedullary nailing in the treatment of patients with multi-segment fracture of complex femoral shaft.Methods：From January 2013 to January 2016,32 patients with multiple fractures segments of femoral shaft were treated with instrumentation-assisted reduction combined with interlocking intramedullary nailing,including 22 males and 10 females with an average age of 45 years old ranging 17 to 68 years old. The time from injured to operation was 5 to 10 days with an average of7 days. After admission,routine tibial tubercle or supracondylar bone traction was performed. The patient＇s general condition was evaluated,the operation time and intraoperative blood loss were recorded. According to Thorsen femoral fracture morphology evaluation criteria and Hohl knee function evaluation of postoperative efficacy,postoperative fracture healing,complications and postoperative recovery of limb function were observed. Results：All patients were followed up for 6 to 24 months with an average of 12 months. The operative time ranged from 48 to 76 minutes with an average of 67 min. The intraoperative blood loss was 150 to 400 ml with an average of 220 ml. The surgical incisions all achieved grade A healing. The fractures reached the clinical standard of healing. The fracture healing time ranged from 4.2 to 10.8 months with an average of 5.7 months. There were no nonunion,incision infection and internal fixation fracture,failure and other complications. According to Thorsen femoral fracture morphology evaluation criteria,the result was excellent in 28 cases,good in 3 cases,fair in 1 case. According to Hohl knee function evaluation criteria,the result was excellent in 30 cases,good in 2 cases. Conclusion：Instrument-assisted reduction combined with interlocking intramedullary nail fixation is a safe and effective method for the treatment of complex femoral shaft fractures. It has advantages of small trauma,fixed fixation,quick recovery,early postoperative functional exercise.