股骨远端复杂骨折的内固定方式选择  

Choice of internal fixation treatment for the complex distal femoral fractures

作　　者：廖春来[1] 王培信[1] 李培浩[1] 曾波[1] 谢逸波[1] 樊滔[1] 梁伟炯[1] 罗杰民[1] 

机构地区：[1]解放军第188医院外三科,广东省潮州市新洋路尾521000

出　　处：《中国矫形外科杂志》2011年第8期624-627,共4页Orthopedic Journal of China

摘　　要：[目的]比较股骨远端复杂骨折2种不同内固定方式的疗效和适应证。[方法]2006年1月～2009年3月,分别采用2种内固定方法治疗成年股骨远端复杂骨折46例,男28例,女18例,年龄26～71岁,平均42.9岁。其中逆行交锁髓内钉固定组20例,加压锁定钢板内固定组26例。X线片按AO/ASIF分型,均属复杂类型骨折（A3、C2、C3型）。[结果]入选病例均获随访16～36个月,平均24个月。切口Ⅰ期愈合,复位满意,无术后感染、内固定物断裂、骨不连、深静脉血栓、肢体短缩、膝内翻畸形等并发症。骨折愈合时间为15～20周,A组平均18.18周,B组平均18.38周,两组间比较无显著差异（P〉0.05）。膝关节功能按Merchan评分标准评估,A组：优11例,良6例,可2例,差1例,优良率达85.0%。B组：优15例,良8例,可2例,差1例,优良率达88.5%。两组间比较差异有显著差异（P〈0.05）。[结论]对于股骨远端的复杂类型骨折,逆行交锁髓内钉和加压锁定钢板均能达到良好的疗效。但本组结果显示,加压锁定钢板系统对膝关节功能恢复疗效确切,适应证更广泛,临床上较逆行髓内钉系统常用。[Objective]To compare the efficacy and indication of two different internal fixation methods for the complex distal femoral fracture.[Method]Forty-six cases of complex distal femoral fracture were treated with 2 internal surgical fixations,with 28 males and 18 females,and with average age of 42.9 years（range,26-71 years）.All cases were divided into 2 groups： retrograde intramedullary nail group（group A,20 cases）,pressure locking plate fixation group（group B,26 cases）.They were confirmed as complex fracture according to X-ray film by AO/ASIF classification（A3,C2,C3）.[Result]All patients were followed up for 16-36 months（average,24 month）.All patients obtained first intention incision healing and satisfactory replacement without complications such as postoperative infection,implant repture,nonunion of bone,deep vein thrombosis,limb shortening,varus deformity.Fracture healing time was 15-20 weeks,18.18 weeks in group A,18.38 weeks in group B,without signifiant difference（P0.05）.According to Merchan classification system,there were 11 excellent results,6 good results,2 fair results and 1 poor result in group A,with goo to excellent rate of 85.0%.There were 15 excellent results,8 good results,2 fair results and 1 poor result in group B.There were fignificant difference between 2 groups（P0.05）.[Conclusion]For the complex distal femoral fracture,both retrograde intramedullary locking nail and compression plate could achieve good results.However,locking compression plate system has good effect of knee functional recovery and more extensive indications than using retrograde intramedullary nail system,so it is more commonly used in clinical

关 键 词：股骨远端骨折 复杂骨折 逆行交锁髓内钉 加压锁定钢板 内固定 

分 类 号：R687.3[医药卫生—骨科学]