关节镜下经皮逆行交锁髓内钉固定治疗股骨髁上骨折  

Treatment of supracondylar femoral fractures using arthroscopically assisted percutaneous retrograde interlocking nailing

作　　者：刘飞[1] 张连清[1] 姜永冲[1] 李群[1] 严宏践[1] 魏卫[1] 李学金[1] 牛增广[1] 

机构地区：[1]河北省秦皇岛市第一医院骨科,066000

出　　处：《中华骨科杂志》2004年第3期167-169,共3页Chinese Journal of Orthopaedics

摘　　要：目的探讨关节镜辅助下经皮逆行交锁髓内钉固定治疗股骨髁上骨折的方法与疗效。方法2001年7月～2003年6月,在关节镜辅助下采用经皮逆行交锁髓内钉固定治疗股骨髁上骨折22例,男10例,女12例;年龄22～65岁,平均39.5岁。摔伤7例,交通伤15例。根据AO/ASIF分类系统,A1型7例,A2型8例,A3型7例。所有患者均在关节镜辅助下采用经皮逆行交锁髓内钉固定治疗。其中,3例关节僵硬者行关节松解术,2例行游离体取出术,7例骨关节炎患者行关节清理及灌洗术。3例陈旧骨折不愈合者行植骨术。结果手术时间为90～210min,平均130min;术中平均出血100ml。术后X线片示骨折复位固定良好。术后随访20例,随访时间6～24个月,平均14个月。除1例骨折未愈合外,其余19例患者于术后2～6个月达骨性愈合,平均3.3个月。20例患者膝关节屈伸活动度均大于90°,无一例发生感染和内固定物断裂等并发症。结论关节镜辅助下经皮逆行交锁髓内钉固定治疗股骨髁上骨折,创伤小、出血少、定位准确,有利于骨折的愈合和膝关节功能的恢复。Objective To discuss the clinical technique and outcomes of the treatment with arthroscopically assisted percutaneous retrograde interlocking nailing for supracondylar femoral fractures. Methods From July 2001 to June 2003, there were 22 supracondylar femoral fractures which were 19 fresh fractures and 3 old fractures. There were 10 males and 12 females, and the average age of which was 39.5 years ranging from 22 to 65 years. 7 patients sustained falls, and the other 15 patients were caused by traffic accidents. According to the AO/ASIF classification system, 7 fractures were evaluated as type A1, 8 type A2 and 7 type A3. All the patients were treated by arthroscopically assisted percutaneous retrograde interlocking nailing. Some additional lesions were also treated under arthroscopy simultaneously, including 3 releases for the stiff knee, 2 removals of the loose bodies, 7 debridements and lavages for the osteoarthritis, and 3 bone grafts for the fracture union. Results The average operative time was 130 minutes ranging from 90 to 210 minutes, and the average blood loss was 100 ml. The reduction and fixation were proved to be satisfactory by the postoperative roentgenogram. 20 patients were available for follow-up, which ranged from 6 to 24 months with an average of 14 months. All the fractures were united on an average of 3.3 months postoperatively except one ranging from 2 to 6 months. The one with fracture union were reoperated with bone grafting and compressive plate fixation, and the fracture healed 3 months later. The range of motion was beyond 90° in all patients, no breakage of internal fixation instruments or wound infection occurred. The functional results of knee joint were assessed as excellent in 14, good in 5 and fair in 1, and the rate of excellent and good was 95%. Conclusion The percutaneous retrograde interlocking nailing for the supracondylar femoral fractures is proved to have many advantages, such as less trauma and blood loss, and accurate location, which are beneficial to both of the fract

关 键 词：关节镜 经皮逆行交锁髓内钉固定 治疗 股骨髁上骨折 

分 类 号：R687[医药卫生—骨科学]