改良股骨远端前外侧入路治疗中青年复杂股骨远端骨折的效果  

Effect of Modified Anterolateral Approach to Distal Femur on Complex Distal Femur Fractures in Young and Middle-Aged Patients

作　　者：骆松[1] 余慧 马泽仁[1] 徐小生[1] 戴闽[2] LUO Song;YU Hui;MA Ze-ren;XU Xiao-sheng;DAI Min(The Ninth Department of Orthopedics,Hongdou Hospital of Traditional Chinese Medicine,Nanchang 330008,China;Department of Orthopedics,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌市洪都中医院骨9科,南昌330008 [2]南昌大学第一附属医院骨科,南昌330006

出　　处：《实用临床医学（江西）》2019年第10期18-21,I0001,共5页Practical Clinical Medicine

摘　　要：目的探讨改良股骨远端前外侧入路联合髁支持钢板治疗中青年复杂股骨远端骨折的疗效。方法采用改良股骨远端前外侧入路联合髁支持钢板,对2012年12月至2018年6月收治并符合标准的52例复杂股骨远端骨折中青年患者进行手术治疗。记录手术时间、术中失血量、住院时间、完全负重时间,采用美国特种外科医院膝关节功能评分(HSS,术后3、6、12个月)及Kolmert(末次随访时)评定患者膝关节功能。结果 52例患者均顺利完成手术并获得随访,随访时间12~40个月,平均25.3个月。手术时间(64.9±10.3)min,术中失血(360.8±45.6)mL,住院时间(12.9.0±2.3)d,完全负重时间(11.92±2.30)周。术后3、6、12个月HSS评分分别为(84.9±4.69)、(90.2±5.37)、(96.6±2.48)分,各观察时间点,HSS评分比较差异有统计学意义(F=39.087,P<0.001)。Kolmert膝关节功能评定:优24例,良20例,可6例,差2例,优良率85%。术后并发症发生率为9.6%(5/52)。结论改良股骨远端前外侧入路联合髁支持钢板治疗中青年复杂股骨远端骨折损伤小,暴露充分,行牢靠内固定后配合早期的功能康复,能提高治疗效果。Objective To evaluate the curative efficacy of improved anterolateral approach combined with condylar buttress plate in the treatment of complicated distal femoral fractures in young and middle-aged patients.Methods Between December 2012 to June 2018,52 young and middle-aged patients with complicated distal femoral fractures were surgically treated with condylar buttress plate through the improved anterolateral approach.The operation time,intraoperative blood loss,hospitalization time and weight loading time were recorded.In addition,Hospital for Special Surgery(HSS) scores of the knee were determined at 3,6 and 12 months after operation,and Kolmert knee functional evaluation was performed at the last follow-up.Results All patients successfully completed the operation,and were followed up for 12-40 months(average,25.3 months).The operation time,intraoperative blood loss,hospital stay and full weight-bearing time were(64.9±10.3) minutes,(360.8±45.6)mL,(12.9.0±2.3) days and(11.92±2.30) weeks,respectively.The scores of HSS were(84.9±4.69),(90.2±5.37) and(96.6±2.48) at 3,6 and 12 months after operation,respectively.The differences in HSS scores were statistically significant among different time points(F=39.087,P<0.001).According to the Kolmert criteria,knee function was excellent in 24 patients,good in 20,fair in 6 patients and poor in 2.The excellent and good rate was 85%.The incidence of postoperative complications was 9.6%(5/52).ConclusionThe improved anterolateral approach combined with condylar buttress plate is associated with small damage and full exposure for treating complicated distal femoral fractures in young and middle-aged patients.Furthermore,solid internal fixation combined with early functional rehabilitation can improve the therapeutic efficacy.

关 键 词：复杂股骨远端骨折 改良股骨远端前外侧入路 髁支持钢板 中青年 

分 类 号：R683.42[医药卫生—骨科学]