C型开放性股骨远端骨折合并髌骨骨折的手术治疗策略  

Treatment strategy of open and type C distal femoral fracture accompanied with patellar fracture

作　　者：孔祥如[1] 杨太明[1] 朱裕成[1] 郑红兵[1] 许兴柏[1] 高先亭[1] 马军[1] 杨春[1] 

机构地区：[1]南京鼓楼医院集团宿迁市人民医院骨科,江苏宿迁223800

出　　处：《中国骨与关节损伤杂志》2015年第10期1040-1043,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的 总结AO分型中C型开放性股骨远端骨折合并髌骨骨折的临床特点及手术治疗策略。方法 回顾性分析自2002-01—2012-12诊治的15例伴髌骨粉碎性骨折的C型开放性股骨远端骨折。除1例因合并腹部内脏损伤、创伤性休克行清创缝合骨牵引二期手术外,其余均急诊手术。先行股骨髁间部分骨折及髁上部分骨折复位固定,同时予自体髂骨植骨,髌骨骨折予多枚克氏针张力带钢丝固定。采用髁支持钢板固定9例,LCP固定5例,逆行髓内钉固定1例。结果本组手术时间85-140 min,平均105.6 min;术中出血量750-2 150 ml,平均1 215.6 ml;术中输血量600-1 900 ml,平均1 075.7 ml。所有患者均获得随访,随访时间18-46个月,平均22.5个月。股骨骨折愈合时间12-44周,平均25.4周;髌骨骨折愈合时间8-12周,平均10.5周。末次随访时膝关节功能按Merchan等标准评定：优6例,良4例,可3例,差2例,优良率66.7%。结论 彻底清创、骨折解剖复位、牢固内固定及一期植骨治疗伴髌骨粉碎性骨折的C型开放性股骨远端骨折可以取得良好疗效,但如何更好地促进膝关节功能恢复仍是临床治疗的一个重要课题。Objective To explore the treatment and clinical effect of open and AO type C distal femoral fracture accompanied with patellar fractures.Methods From January 2002 to December 2012,15 patients with open and type C distal femoral fracture accompanied with patellar fracture accepted surgical treatment were retrospectively analyzed.All patients were given emergency surgery,expect 1 case of visceral injury,traumatic shock due to give debridement suture and with bone traction phase to the secondary operation.Super-condylar distal femoral fracture was reduced and fixed followed by intra-condylar fracture,Auto-iliac bone graft was used in all patients.Patellar fracture was fixed with Kirschner tension band.Condylar plates were used in 9 patients,LCP in 5 patients,retrograde intramedullary nailing in 1 patient.Results The operation time of this group was 85-140 min（average 105.6 min）.Intraoperative bleeding amount ranged from 750 to 2 150 ml（average 1 215.6 ml）,intraoperative blood transfusion volume from 600 to 1 900 ml（average 1 075.7 ml）.All patients were followed up 18-46 months（average 22.5 months）.The healing time of femoral fracture was 12 to 44 weeks post-operatively（average 25.4 months）.The healing time of patellar fracture was 8 to 12 weeks post-operatively（average 10.5 months）.According to Merchan knee joint function criterion,6 cases were excellent,4 cases good,3 cases fair,2 cases poor.Conclusion Completed debridement,anatomical fracture reduction,solid fixation and bone graft are effective for treatment of open and AO type C distal femoral fracture accompanied with patellar fracture.But how to promote the knee function is still an important subject of clinical treatment.

关 键 词：C型股骨远端骨折 髌骨骨折 开放性骨折 解剖复位 内固定 

分 类 号：R687.3[医药卫生—骨科学]