四种内固定方式治疗股骨远端骨折的疗效比较  

A comparative analysis of 4 internal fixation methods for distal femoral fractures

作　　者：杨永良[1] 周东生[1] 张庆斌[1] 王国栋[1] 辛茂源[1] 李庆虎[1] 

机构地区：[1]山东大学附属省立医院(山东省骨科医院)创伤骨科,济南250021

出　　处：《中华创伤骨科杂志》2012年第11期954-958,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的比较4种内固定方式治疗股骨远端骨折的疗效，以期指导临床合理选择和应用。方法对2004年6月至2011年6月期间收治且获得随访的92例股骨远端骨折患者资料进行回顾性分析，根据内固定方式不同分为4组：动力髁螺钉（DCS）组15例，男8例，女7例；平均年龄为（47．3±3．8）岁。解剖钢板组17例，男10例，女7例；平均年龄为（49．5±2．6）岁。微创内固定系统（LISS）组24例，男13例，女ll例；平均年龄为（46．8±6．5）岁。逆行髓内钉组36例，男20例，女16例；平均年龄为（50．2±4．3）岁。比较4组患者的骨折愈合率、美国特种外科医院（HSS）膝关节功能评分及并发症的发生情况。结果92例患者术后获12-36个月（平均17．8个月）随访。术后1年DCS组、解剖钢板组、LISS组及逆行髓内钉组患者的骨折愈合率分别为80．0％（12／15）、76．5％（13／17）、91．7％（22／24）、97．2％（35／36），其中解剖钢板组与逆行髓内钉组比较差异有统计学意义（P〈0．05）。4组患者HSS膝关节功能评分优良率分别为73．3％（11／15）、70．6％（12／17）、87．5％（21／24）、94．4％（34／36），逆行髓内钉组优良率明显高于DCS组和解剖钢板组，差异均有统计学意义（P〈0．05）。4组患者术后并发症的发生率分别为26．7％（4／15）、23．5％（4／17）、16．7％（4／24）及11．1％（4／36），逆行髓内钉组明显低于DCS组和解剖钢板组，差异均有统计学意义（P〈0．05）。结论与DCS及股骨远端锁定钢板比较，逆行髓内钉治疗股骨远端骨折具有骨折愈合率高和功能恢复满意等优点，获得了与LISS系统相似的临床效果，是治疗股骨远端骨折的一种有效方法。Objective To compare the outcomes of 4 internal fixation methods in the treatment of distal femoral fractures. Methods From June 2004 to June 2011, 92 patients with distal femoral fracture were treated and followed fully in our hospital. They were divided into 4 groups according to the fixation methods. Dynamic condylar screws （DCS） were used in 15 cases, 8 males and 7 females, with an average age of 47.3 ± 3.8 years, distal femoral anatomical plates （AP） were used in 17 cases, 10 males and 7 females, with an average age of 49.5 ± 2.6 years. Less invasive stabilization system （L1SS） was used in 24 cases, 13 males and 11 females, with an average age of 46.8± 6.5 years. Retrograde interlocking intramedullary nails （RIMN） were used in 36 cases, 20 males and 16 females, with an average age of 50. 2 ±4.3 years. The 4 groups were compared in terms of fracture union, The Hospital for Special Surgery （HSS） scores of the knee function and complications. Results The patients were followed up from 12 to 36 months （average, 17.8 months）. One-year follow-ups showed the bone union rates were 80.0% （12/15） for DCS group, 76.5% （13/17） for AP group, 91.7% （22/24） for LISS group and 97.2% （35/36） for RIMN group, with a significant difference between AP and RIMN groups （ P 〈 0. 05）. By HSS scores, the good to excellent rates were 73.3% （ 11/15） for DCS group, 70.6% （12/17） for AP group, 87.5% （21/24） for LISS group and 94.4% （34/36） for RIMN group, RIMN group being significantly higher than DCS and AP groups （ P 〈 0. 05）. The rates of complication in DCS, AP, LISS and RIMN groups were 26.7% （4/15）, 23.5% （4/17）, 16.7% （4/24） and 11. 1% （4/36） respec- tively, RIMN group being significantly lower than DCS and AP groups （ P 〈 0. 05） . Conclusions As an effective method to treat distal femoral fractures, RIMN may be superior to DCS and AP in terms of bone union and functional recovery. It is comparable with LISS in clinical outcomes.

关 键 词：股骨骨折 骨折固定术 内 骨钉 骨板 外科治疗 微创性 

分 类 号：R687.3[医药卫生—骨科学]