三种内固定方式治疗股骨远端Müller分型C2和C3型骨折的疗效比较

Comparison of three internal fixation methods for distal femoral fractures of Müller types C2 and C3

目的比较3种内固定方式治疗股骨远端Müller分型C2、C3型骨折的疗效。方法回顾性分析2013年2月至2017年2月期间宁波市第六医院创伤骨科收治的58例股骨远端Müller分型C2、C3型骨折患者资料。根据内固定方式不同分为3组:单切口锁定钢板组(A组)21例,男13例,女8例;年龄为(50.6±12.9)岁。双切口锁定钢板联合重建钢板组(B组)18例,男11例,女7例;年龄为(53.5±13.0)岁。单切口锁定钢板联合重建钢板组(C组)19例,男10例,女9例;年龄为(48.1±12.2)岁。比较3组患者的手术时间、术中出血量、术中C型臂透视次数、骨折愈合时间、术后并发症发生率、膝关节活动度及膝关节功能等。结果3组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。3组患者术中C型臂透视次数、随访时间及术后并发症发生率比较差异均无统计学意义(P>0.05)。但A组、C组患者的手术时间[(96.7±16.4)、(101.9±16.5)min]和术中出血量[(237.8±47.5)、(253.6±46.6)mL]显著少于B组患者[(114.9±20.1)min、(290.1±60.9)mL],差异均有统计学意义(P<0.05)。B组、C组患者的骨折愈合时间[(6.9±1.6)、(6.6±1.7)个月]显著短于A组患者[(8.4±1.9)个月],术后12个月膝关节活动度(91.7°±16.7°、90.9°±14.4°)显著大于A组患者(78.8°±14.4°),术后12个月膝关节功能恢复优良率[77.8%(14/18)、73.7%(14/19)]显著高于A组患者[57.1%(12/21)],差异均有统计学意义(P<0.05)。结论采用股骨远端前外侧切口外侧应用锁定钢板、前侧附加重建钢板固定治疗股骨远端Müller分型C2、C3型骨折,固定坚强、对周围软组织损伤相对较小,兼具单切口锁定钢板和双切口内外侧锁定钢板固定的优点,术后患者膝关节功能恢复良好。

Objective To compare 3 internal fixation methods for the treatment of distal femoral fractures of Müller types C2 and C3.Methods The clinical data of 58 patients were retrospectively analyzed who had been treated for distal femoral fractures of Müller types C2 and C3 at Department of Orthopaedic Trauma,Ningbo No.6 Hospital from February 2013 to February 2017.They were divided into 3 groups according to the internal fixation method they had used.In the single incision locking plate group(group A)of 21 cases,there were 13 males and 8 females with an age of 50.6 years±12.9 years.In the double-incision locking plate combined with reconstruction plate group(group B)of 18 cases,there were 11 males and 7 females with an age of 53.5 years±13.0 years.In the single incision locking plate combined with reconstruction plate group(group C)of 19 cases,there were 10 males and 9 females with an age of 48.1 years±12.2 years.The 3 groups were compared in terms of operation time,intraoperative blood loss,intraoperative C-arm fluoroscopy,fracture healing time,incidence of postoperative complications,range of motion of the knee and knee functional recovery.Results The 3 groups were compatible because there were no significant differences between them in their preoperative general data(P>0.05).There were no significant differences between groups in the frequency of C-arm fluoroscopy,follow-up time,or incidence of postoperative complications(P>0.05).The operation time in groups A and C(96.7 min±16.4 min and 101.9 min±16.5 min)and intraoperative blood loss for groups A and C(237.8 mL±47.5 mL and 253.6 mL±46.6 mL)were significantly less than in group B(114.9 min±20.1 min and 290.1 mL±60.9 mL)(P<0.05);the fracture healing time for groups B and C(6.9 months±1.6 months and 6.6 months±1.7 months)was significantly shorter than for group A(8.4 months±1.9 months)(P<0.05);the ranges of knee motion 12 months after operation in groups B and C(91.7°±16.7°and 90.9°±14.4°)were significantly larger than that in group A(78.8°±14.4°)(P<0.05);the excellent and good rates of knee function 12 months after operation in groups B and C[77.8%(14/18)and 73.7%(14/19)]were significantly higher than that in group A[57.1%(12/21)](P<0.05).Conclusion In the treatment of distal femoral fractures of Müller types C2 and C3,application of lateral locking plate and additional anterior locking reconstruction plate via the anterolateral incision at the distal femur can achieve rigid fixation without much damage to the surrounding soft tissues and lead to fine functional recovery of the knee joint because it has the advantages of single incision locking plate and double incision medial and lateral locking plates.