顺行交锁钉结合微创内固定系统钢板固定治疗LambirisⅢ或Ⅳ型股骨骨折的疗效分析

Treatment of femoral fractures (Lambiris type Ⅲ or Ⅳ) with antegrade interlocking intramedullary nails combined with less invasive stabilization system

目的探讨顺行交锁髓内钉结合微创内固定系统(LISS)钢板固定治疗LambirisⅢ或Ⅳ型股骨骨折的疗效。方法回顾性分析2015年2月至2019年5月期间武汉市第四医院骨科收治的27例LambirisⅢ或Ⅳ型股骨骨折患者资料。男21例,女6例;年龄为22~57岁,平均41.3岁。骨折根据Lambiris分型:Ⅲ型24例(Ⅲa型17例,Ⅲb型5例,Ⅲc型2例),Ⅳ型3例。受伤至手术时间为2~9 d,平均4.3 d。所有患者均采用顺行股骨交锁髓内钉结合LISS钢板固定治疗。记录患者的手术时间、术中出血量、住院时间、骨折愈合时间、末次随访时髋关节功能、膝关节功能及并发症发生情况等。结果本组患者的手术时间平均为2.1 h(1.8~2.5 h),术中出血量平均为361 mL(310~480 mL),住院时间平均为15.1 d(11~18 d)。27例患者术后获13~38个月(平均25.3个月)随访。所有患者骨折愈合良好,愈合时间平均为29.2周(28~36周)。末次随访时按髋关节Harris评分标准评定髋关节功能:优18例,良6例,可3例,优良率为88.9%(24/27);按照美国纽约特种外科医院膝关节功能评分标准评定膝关节功能:优16例,良7例,可4例,优良率为85.2%(23/27)。随访期间无一例患者发生骨不连、畸形愈合、再次骨折、内固定物松动及断裂等并发症。结论顺行交锁髓内钉结合LISS钢板固定治疗LambirisⅢ或Ⅳ型股骨骨折具有固定坚强、并发症少等优点,患者骨折愈合率高,功能恢复好。

Objective To evaluate antegrade interlocking intramedullary nails combined with less invasive stabilization system(LISS)in the treatment of femoral fractures(Lambiris typeⅢorⅣ).Methods The clinical data of 27 patients were retrospectively analyzed who had been treated for femoral fractures of Lambiris typeⅢorⅣat Department of Orthopedic Surgery,Wuhan Fourth Hospital from February 2015 to May 2019.They were 21 males and 6 females,aged from 22 to 57 years(average,41.3 years).According to the Lambiris classification,24 cases were classified as typeⅢ(17 as typeⅢa,5 as typeⅢb and 2 as typeⅢc)and 3 cases as typeⅣ.The time from injury to operation ranged from 2 to 9 days(average,4.3 days).All the fractures were fixated with anterograde femoral interlocking nails and femoral LISS.Recorded were operation time,intra-operative blood loss,hospital stay,bone healing time,and Harris hip score,Hospital for Special Surgery(HSS)knee score and complications at the final follow-up.Results In this cohort,operation time averaged 2.1 h(from 1.8 to 2.5 h),intraoperative blood loss 361 mL(from 310 to 480 mL),and hospital stay 15.1 d(from 11 to 18 d).All the 27 patients were followed up for 13 to 38 months(average,25.3 months)after operation.All the fractures united well after an average duration of 29.2 weeks(from 28 to 36 weeks).By the Harris hip scores at the final follow-up,the hip function was evaluated as excellent in 18 cases,as good in 6 and as acceptable in 3,giving an excellent and good rate of 88.9%(24/27);by the HSS knee scores at the final follow-up,the knee function was excellent in 16 cases,good in 7 and acceptable in 4,giving an excellent and good rate of 85.2%(23/27).Follow-ups observed no fracture nonunion,malunion,refracture,internal fixation failure or other complications.Conclusion In the treatment of femoral fractures of Lambiris typeⅢorⅣ,antegrade interlocking intramedullary nails combined with LISS has advantages of rigid fixation,a high rate of fracture union,limited complications,and good functional recovery.