轴向牵引下股骨远端骨折闭合复位钢板内固定

Closed reduction and plate fixation for distal femoral fractures under axial distraction

[目的]介绍下肢轴向牵引器闭合复位钢板内固定治疗股骨远端骨折的手术技术及初步临床效果。[方法] 2017年07月—2019年06月采用下肢轴向牵引器闭合复位钢板内固定治疗股骨远端骨折26例患者。A型骨折需先自股骨髁逆行插入钢板后经钢板安装牵引器牵开复位并固定,C型骨折先行复位并固定髁间骨折,逆行插入钢板后安装牵开器进行牵开复位及固定。[结果]所有患者均顺利完成手术,无严重并发症发生。随访期间发生膝关节僵硬2例,骨折端延迟愈合1例,术后1年根据Schatzker-Lambert标准对患肢功能进行评估:优20例,良5例,优良率96.2%。术后正侧位与术前相比成角畸形明显改善(P<0.05)。[结论]下肢轴向牵引器应用于股骨远端骨折闭合复位钢板内固定手术操作方便,能有效提高术中闭合复位效率。

[Objective] To introduce the surgical technique and preliminary clinical outcomes of closed reduction and plate fixation under axial distraction. [Methods] From July 2017 to June 2019, 26 patients received closed reduction and plate fixation under axial distraction for distal femoral fractures. For type A fracture, the plate was inserted retrogradely from the femoral condyle, and then the distractor was installed through the plate to achieve reduction and fixation. However, the reduction and fixation of intercondylar fracture were conducted firstly by constant axial distraction produced by the distractor, and then the plate would be inserted retrogradely for type C fracture. [Results] All of these patients had operation performed smoothly, without serious intraoperative or postoperative complications. Among them, 2 patients had knee stiffness and one had delayed-union, which were overcame by corresponding management. At 1 year after operation, the clinical outcome was graded as excellent in 20 patients and good in 5 patients based on the Schatzker-Lambert criteria, with satisfactory rate of 96.2%. Regarding radiographic assessment, the angular deformities of the fractures were significantly corrected postoperatively compared with those preoperatively(P<0.05). [Conclusion] The distractor is simple and easy to operate, which can improve the efficiency of closed reduction for distal femoral fracture.