胫骨逆行髓内钉联合微创内固定系统治疗股骨远端骨折  

The clinical efficacy of retrograde tibial intramedullary nail combined with lateral less invasive stabilization system in the treatment of distal femoral fractures

作　　者：徐维臻 丁真奇[1] 刘晖[1] 张金辉 熊远飞 林伟斌 吴进[1] Xu Weizhen;Ding Zhenqi;Liu Hui;Zhang Jinhui;Xiong Yuanfei;Lin Weibin;Wu Jin(Department of Orthopaedics,the 909th Hospital(Dongnan Hospital of Xiamen University),Zhangzhou 363000,China)

机构地区：[1]第九〇九医院(厦门大学附属东南医院)骨科,漳州363000

出　　处：《中华骨科杂志》2025年第4期197-204,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨胫骨逆行髓内钉(retrograde tibial intramedullary nail,RTN)联合股骨远端外侧微创内固定系统(less invasive stabilization system,LISS)治疗股骨远端骨折的临床疗效。方法回顾性分析2021年6月至2022年12月于第九〇九医院接受RTN联合LISS锁定钢板治疗的11例股骨远端骨折患者资料,男5例、女6例,年龄(56.5±17.5)岁;骨折分型AO/OTA分型33A2型2例、A3型2例、C1型2例、C2型2例,全膝关节置换术后股骨假体周围骨折3例(均为RorabeckⅡ型)。行胫骨逆行髓内钉联合LISS治疗,记录手术时间、术中出血量、骨折愈合时间、完全负重时间、股胫角、膝关节活动度(range of motion,ROM)、美国特种外科医院(Hospital for Special Surgery,HSS)评分、疼痛视觉模拟评分(visual analogue scale,VAS)和并发症情况。结果11例均顺利完成手术,手术时间为(98.3±9.0)min(范围83~115 min),术中出血量为(167.8±24.3)ml(范围120~210 ml)。11例均获得随访,随访时间为(11.0±1.9)个月(范围9~15个月);骨折愈合时间为术后(5.3±0.8)个月(范围4~6个月);术后完全负重活动时间为(55.7±6.5)d(范围46~67 d)。末次随访时11例的股胫角为171.2°±1.8°(范围169°~174°)、膝关节ROM为129.5°±4.7°(范围120°~135°)、HSS评分为(86.8±6.9)分(范围69~95分)、VAS为(1.5±1.1)分(范围0~3分)。除1例术后出现手术切口浅表感染,其余患者无其他并发症发生。结论RTN联合外侧LISS治疗股骨远端骨折创伤小、固定可靠,利于快速康复,术后并发症少。Objective To explore the clinical efficacy of retrograde tibial intramedullary nail(RTN)combined with less invasive stabilization system(LISS)in the treatment of distal femoral fractures.MethodsA retrospective analysis was conducted on the data of 11 patients with distal femoral fractures who underwent RTN combined with LISS locking plate treatment at the 909th Hospital from June 2021 to December 2022.There were 5 males and 6 females,with an average age of 56.5±17.5 years.The fracture types were AO/OTA 33A2 in 2 cases,A3 in 2 cases,C1 in 2 cases,and C2 in 2 cases.There were 3 cases of periprosthetic femoral fractures after total knee arthroplasty(TKA),all classified as Rorabeck typeⅡ.They were treated with retrograde intramedullary nailing of the tibia combined with a minimally invasive lateral internal fixation system.The operation time,intraoperative blood loss,fracture healing time,full weight-bearing time,femorotibial angle,range of motion(ROM)of the knee joint,Hospital for Special Surgery(HSS)score,visual analogue scale(VAS)for pain,and complications were recorded.ResultsThe operation was successfully completed in all 11 cases.The operation time was 98.3±9.0 min(range 83-115 min),and the intraoperative blood loss was 167.8±24.3 ml(range 120-210 ml).All 11 cases were followed up for 11.0±1.9 months(range 9-15 months).The healing time of 11 cases was 5.3±0.8 months(range 4-6 months)after operation.The time of complete weight-bearing activity after operation was 55.7±6.5 d(range 46-67 d).At the last follow-up,the femoral-tibial angle of 11 cases was 171.2°±1.8°(range 169°-174°),the ROM of knee joint was 129.5°±4.7°(range 120°-135°),and the HSS score was 86.8±6.9 points(range 69-95 points).There were no major complications except for one case of superficial infection of surgical incision after operation.ConclusionRTN combined with lateral LISS locking plate showed good clinical effect with the advantages of less trauma,reliable fixation,rapid recovery,less postoperative complications.

关 键 词：股骨骨折 骨折固定术 髓内 内固定器 骨板 

分 类 号：R687.3[医药卫生—骨科学]