有限切开手术治疗老年股骨髁上骨折的临床研究  

Treatment Evaluation of Different Minimally Invasive Surgery for Elderly Patients with Supracondylar Fracture Femur

作　　者：宋登新[1] 傅燕飞[1] 刘成文[1] 张明贵[1] 何小文[1] 吴子征[1] 

机构地区：[1]上海市第一人民医院宝山分院骨科,上海200940

出　　处：《实用骨科杂志》2011年第5期398-401,共4页Journal of Practical Orthopaedics

摘　　要：目的探讨有限切开锁定钢板和逆行髓内钉手术治疗老年人股骨髁上骨折的疗效。方法 2000年1月至2008年1月,治疗老年人闭合性股骨髁上骨折69例,采用有限切开锁定钢板治疗37例,男性15例,女性22例,年龄61～82岁,平均71.5岁,受伤至手术时间3～9 d,平均6 d;采用有限切开逆行髓内钉治疗32例,男性19例,女性13例,年龄60～86岁,平均73岁,受伤至手术时间3～7 d,平均5 d。结果 69例均获随访,随访时间25～39个月,平均28个月,无内固定断裂、感染。参考K ilm er评价标准评分,有限切开逆行髓内钉组优19例,良11例,一般2例,优良率93.75%;有限切开锁定钢板组优14例,良17例,一般6例,优良率83.78%;差异有统计学意义(P<0.05)。有限切开逆行髓内钉组手术时间(73±28)min,出血量(530±140)mL,术后并发症4例;有限切开锁定钢板组手术时间(55±23)min,出血量(180±50)mL,无术后并发症,差异有统计学意义(P<0.05)。结论有限切开锁定钢板和逆行髓内钉是治疗老年人股骨髁上骨折的有效方法,逆行髓内钉的疗效优于锁定钢板,但锁定钢板手术简单、出血量和并发症少,因此老年患者应根据临床特点灵活选择,以减少手术不良反应,提高疗效。Objective To evaluate the therapeutic effects of retrograde interlocking intramedullary nailing and locked plate under microtrauma operation on supracondylar femoral fractures in elderly patients.Methods From January 2000 to January 2008,69 elderly patients with closed supracondylar femoral fracture were treated by microtrauma operation using locked plate in 37 and retro-interlocking intramedullary nail in 32.The patients were allocated to one of the two groups randomly and followed.In the group of locked plate,there were 15 males and 22 females with an average of 71.5 years（range 61～82 years）.The disease course was 3 to 9 days（an average of 6 days）,and in the group of retro-interlocking intramedullary nail,there were 19 males and 13 females with an average of 73 years（range60～86 years）.The disease course was 3 to 7 days（an average of 5 days）,and the function of knee joints were followed.Results More than 25months（an average of 28 months,range 25～39 months） follow-up study after operation revealed that there was no implant breakage and infection.According to the Kilmer criteria,there were 19 excellent,11 good and 2 fair in the group of retro-interlocking intramedullary nail（the rate of excellent and good were 93.75%）,and there were 14 excellent,17 good and 6 fair in the group of locked plate（the rate of excellent and good were 83.78%）,the difference between the two groups were significant（P0.05）.Otherwise,the group of locked plate have less operation time（55±23） minutes,bleeding（180±50） mL and complications（0 case） than retro-interlocking intramedullary nail（73±28） minutes,（530±140） mL,4 cases,and the difference were significant（P0.05）.Conclusion The two microtrauma operation were effective methods to treat the elderly patient with supracondylar fracture of femur,and no technique is superior to the other under all circumstances,retrograde interlocking intramedullary nailing under microtrauma operation was better than locked plate in function recove

关 键 词：股骨髁上骨折 有限切开 骨质疏松 锁定钢板 逆行髓内钉 

分 类 号：R683.42[医药卫生—骨科学]