新型股骨远端前外侧入路治疗股骨远端C型骨折疗效分析  

NEW ANTEROLATERAL APPROACH OF DISTAL FEMUR FOR TREATMENT OF TYPE C DISTAL FEMORAL FRACTURES

作　　者：骆松[1] 戴闽[1] 丁志辉[2] 张斌[1] 邹帆[1] 邱平[1] 李斌华[1] 

机构地区：[1]南昌大学第一附属医院骨科,南昌330006 [2]南昌市洪都中医院创伤骨1科

出　　处：《中国修复重建外科杂志》2014年第4期414-418,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 通过与常规股骨远端外侧及前外侧入路比较,探讨采用新型股骨远端前外侧入路治疗股骨远端C型骨折的疗效。方法 回顾性分析2008年1月-2011年8月收治的51例股骨远端C型骨折患者临床资料,其中24例采用新型股骨远端前外侧入路联合股骨髁支持钢板固定（改良组）,27例采用常规前外侧或外侧入路联合股骨髁支持钢板固定（常规组）。两组患者性别、年龄、致伤原因、美国麻醉师协会（ASA）分级、骨折侧别、骨折分型、合并症及受伤至手术时间等一般资料比较,差异均无统计学意义（P〉0.05）,具有可比性。记录两组患者手术时间、术中出血量、术中透视次数、住院时间、骨折愈合时间及术后3、6、12个月膝关节功能美国特种外科医院（HSS）评分。结果 两组患者均顺利完成手术,术后切口均Ⅰ期愈合。改良组手术时间、术中透视次数显著少于常规组（P〈0.05）,术中出血量及住院时间与常规组比较差异均无统计学意义（P〉0.05）。两组患者均获随访,随访时间12～37个月,平均21.3个月。X线片复查示,两组骨折均愈合,改良组骨折愈合时间为（12.92±2.24）周,常规组为（13.24±2.52）周,比较差异无统计学意义（t=0.476,P=0.637）。术后3、6、12个月改良组HSS评分均高于常规组（P〈0.05）。两组膝内翻或外翻畸形、双下肢不等长、内固定物松动、膝关节屈曲障碍、创伤性膝关节炎发生率及并发症总发生率比较,差异均无统计学意义（P〉0.05）。结论 与常规股骨远端外侧及前外侧入路比较,新型股骨远端前外侧入路治疗股骨远端C型骨折软组织损伤更小、术中暴露更充分、手术时间短、术中透视次数少、术后膝关节功能恢复更佳。Objective To study the effectiveness of a new anterolateral approach of distal femur in the treatment of type C distal femoral fractures by comparing with traditional lateral and anterolateral approaches. Methods The clinical data of 51 patients with type C distal femoral fractures treated between January 2008 and August 2011 were retrospectively analyzed. Of 51 patients, 24 patients received the new anterolateral approach of distal femur combined with fixation of condylar buttress plate （modified group）, and 27 patients underwent traditional lateral or anterolateral approach combined with fixation of condylar buttress plate （traditional group）. There was no significant difference in gender, age, injury cause, American Society of Anesthesiologist （ASA） classification, side, fracture type, complication, and the time from injury to operation between 2 groups （P 〉 0.05）. The operation time, intraoperative blood loss, frequency of intraoperative fluoroscopy, hospitalization time, fracture healing time, and Hospital for Special Surgery （HSS） scores of the knee at 3, 6, and 12 months were recorded. Results The operation was successfully completed and the incision healed by first intention in all patients. The operation time and frequency of intraoperative fluoroscopy of modified group were significantly less than those of traditional group （P 〈 0.05）. But the intraoperative blood loss and the hospitalization time showed no significant difference between 2 groups （P 〉 0.05）. All patients were followed up 12-37 months （mean, 21.3 months）. X-ray films showed all fractures were union. The fracture healing time was （12.92 ＋ 2.24） weeks in the modified group and （13.24 ＋ 2.52） weeks in the traditional group, showing no significant difference （t=-0.476, P=0.637）. The knee HSS scores of modified group were significantly higher than those of traditional group at 3, 6, and 12 months after operation （P 〈 0.05）. There was no significant difference in the incidence of knee

关 键 词：股骨远端 C 型骨折 新型股骨远端前外侧入路 股骨髁支持钢板 骨折内固定 

分 类 号：R687.3[医药卫生—骨科学]