多向锁定带锁髓内钉顺行固定股骨远端骨折  

The fixation of distal femoral fracture with antegrade multi-interlocking femoral intramedullary nail

作　　者：王永清[1] 高庆[1] 毕红宾[1] 战颖[1] 赵志辉[1] 杨志强[1] 郝晓辉[1] 尹鸣熹[1] 綦凤桐[1] 熊超[1] 白滨[1] 郭科民[1] 

机构地区：[1]南开大学附属第四中心医院骨科,天津300140

出　　处：《中华骨科杂志》2013年第1期44-49,共6页Chinese Journal of Orthopaedics

基　　金：天津市卫生局科技基金项目（09ky08）

摘　　要：目的总结多向锁定股骨带锁髓内钉（multi-interlocking femoral intramedullary nail,MIFIN）顺行固定股骨远端骨折的方法和疗效。方法回顾性分析2003年1月至2011年12月，应用MIFIN治疗股骨远端骨折43例患者资料，男29例，女14例；年龄21-78岁，平均35．5岁；左侧20例，右侧23例；新鲜骨折40例，陈旧性骨折3例；开放性骨折5例，闭合性骨折38例。AO分型：A1型12例，A2型11例，A3型7例，C1型6例，C2型4例，C3型3例；闭合复位10例，切开复位33例。结果43例患者中，除3例陈旧性骨折和9例髓腔较小的患者经扩髓后穿入MIFIN外，余31例均未扩髓穿钉。术后1~4周，行无痛膝关节功能锻炼。43例患者均获得随访，随访时间为19．3-57个月，平均33．5个月。骨折均完全愈合，愈合时间为4．3-25个月，平均6-2个月。术后美国特种外科医院膝关节功能评分为55-97分，平均85．2分；其中优26例，良7例，可6例，差4例，优良率为76．74％（33／43）。正位X线片示下肢力线外翻〈4°8例，4°～6°30例，〉6°5例。侧位x线片示膝关节伸直位均在0°；屈曲超过90°38例，70°-90°3例，45°-70。2例。结论顺行MIFIN固定股骨远端骨折疗效满意，可避免两次膝关节开放手术的损伤，降低膝关节粘连、功能障碍和感染率。Objective To evaluate the operation methods and curative effect of fixation of distal femoral fractures with antegrade multi-interlocking femoral intramedullary nail （MIFIN）. Methods Data of 43 patients who had undergone reduction and fixation with antegrade MIFIN for femoral condyle and supra- condylar fractures from January 2003 to December 2011 were retrospectively analyzed. There were 29 males and 14 females, aged from 21 to 78 years （average, 35.5 years）. Twenty cases of fracture were on the left, while 23 cases on the right, including 40 cases of fresh fracture and 3 cases of old fracture, as well as 5 cas- es of opened fracture and 38 cases of closed fracture. According to the AO classification, there were 12 cas- es of type AI, ll cases of A2, 7 cases of A3, 6 cases of C1, 4 cases of C2 and 3 cases of C3. Thirty three patients underwent opened reduction, while 10 patients underwent closed reduction. Results The medullary cavities of 31 patients were not reamed before inserting intramedullary nail, except 3 cases of old fracture and 9 cases of smaller medullary cavity. All patients began functional exercise of the knee 1 to 4 weeks after operation. All of them were followed up for 19.3 to 57 months （average, 33.5 months）. All fractures obtained bone union, 4.3 to 25 months after operation （average, 6.2 months）. At final follow-up, according to hospital for special surgery （HSS） knee score, the result was excellent in 26 patients, good in 7 patients, fair in 6 pa- tients and poor in 4 patients, and the overall excellent and good rate was 76.74%（33/43）. The knee valgus angle was less than 4° in 8 patients, between 4° and 6° in 30 patients, larger than 6° in 5 patients, accord- ing to the anterioposterior X-rays. The lateral X-rays showed the knee could extend to 0° in all patients, and the range of flexion was more than 90° in 38 cases, 70° to 90° in 3 cases and 45° to 70° in 2 cases. Conclusion The fixation of distal femoral fracture with antegrade MIFIN is satisfactory, wh

关 键 词：股骨骨折 内固定器 骨折固定术 髓内 

分 类 号：R687.3[医药卫生—骨科学]