改良前外侧肌间隙入路治疗股骨远端C型骨折  

Modified Anterolateral Approach of Treatment of Type C Distal Femoral Fractures

作　　者：杨光煦[1] 刘启圣[1] 

机构地区：[1]第二军医大学长征医院南京分院,江苏南京210000

出　　处：《实用骨科杂志》2016年第7期591-595,共5页Journal of Practical Orthopaedics

摘　　要：目的探究改良股骨远端外侧肌间隙入路治疗股骨远端C型骨折的疗效及安全性。方法选取我院2012年1月至2014年1月手术治疗的股骨远端C型骨折患者64例,根据不同手术入路分成改良组和常规组各32例。常规组行常规股骨前外侧肌间隙入路,改良组切口沿大腿外侧弧形向上先后达股四头肌扩张部和髌骨外侧,最终止于胫骨结节,为新型股骨远端前外侧肌间隙入路。回顾性分析两组患者的临床资料,比较治疗一般情况、术后各时间点膝关节美国特种外科医院(hospital for special surgery,HSS)评分、并发症情况以及治疗的优良率。结果改良组的平均手术时间、术中出血量以及术中透视次数均明显低于常规组,差异均有统计学意义(P<0.05),两组患者的术后平均住院时间和骨折愈合时间差异无统计学意义(P>0.05)。术后各期改良组患者膝关节HSS评分均明显高于常规组,差异均有统计学意义(P<0.05)。随访期间,部分患者出现膝内翻或外翻、双下肢不等长、内固定物松动等手术相关并发症,改良组的总发生率低于常规组,但差异无统计学意义(P>0.05)。根据Kolmert评价标准,至术后12个月时,改良组的优良率明显高于常规组,差异有统计学意义(P<0.05)。结论与传统股骨远端前外侧肌间隙入路相比,改良后的前外侧入路具有对软组织损伤小、骨折区域暴露充分等优势,降低了手术难度,患者术后恢复效果更好,值得临床推广。Objective To explore the effect of new anterolateral approach of distal femur in treatment of type C distal femoral fractures. Methods 64 cases of patients with type C distal femoral fractures in our hospital between Jan. 2012 to Jan.2014 were selected. 32 patients received the new anterolateral approach of distal femur combined with fixation of condylar buttress plate（ modified group）,and 32 patients underwent traditional anterolateral approach combined with fixation of condylar buttress plate（ conventional group）. The clinical data of two group was compared. Results The average operation time,intraoperative blood loss and intraoperative X-ray times of modified group were significantly lower than those of conventional group（P〈0. 05）; there were no significant differences in average hospital stay and fracture healing time of two groups. The HSS scores of modified group were significantly higher than those of conventional group after the operations（P〈0. 05）. There was no significant difference of two groups in complication rate（P〈0. 05）. The excellent rate of modified group was significantly higher than that of conventional group（P〈0. 05）. Conclusion The effect of new anterolateral approach of distal femur of treatment of type C distal femoral fractures is better than traditional operative approach. It is worth of clinical promotion.

关 键 词：股骨远端骨折 前外侧肌间隙入路 改良 切开复位内固定术 

分 类 号：R683.42[医药卫生—骨科学]