股骨远端复杂骨折的手术治疗

・论著・

股骨远端复杂骨折的手术治疗

刘王番　蔡玉辉　赵剑　曹毅　顾永强　严勋

【摘要】　目的　评价应用髁动力加压钢板(DCS )、股骨髁上逆向交锁髓内钉(GSHN )或股骨髁

支撑钢板内固定治疗股骨远端复杂骨折的临床疗效。方法　手术治疗34例(36侧)股骨远端复杂骨折。开放性骨折9侧,闭合性骨折27侧;AO/ASIF 分类A3型16侧,C2型9侧,C3型11侧。17侧选用了切开复位DCS 内固定的方法进行治疗,7侧使用GSHN 固定,12侧选用了切开复位股骨髁支撑钢板内固定的方法。术后5～7d 在CPM 机辅助下行渐进性膝关节功能锻炼。结果　随访6～43个月。36侧骨折中,无一例感染及骨折不愈合发生。按K olment 疗效评定标准评定:优19侧,良11侧,可5侧,差1侧,优良率为8313%。结论　手术治疗股骨远端复杂骨折获得满意疗效需要满足以下条件:力争达到解剖复位;坚强的内固定;尽可能保护骨折断端血供,减少骨折处及其周围软组织的损伤;能提供术后相对早期的康复训练的基础。应用DCS 或GSHN 治疗股骨远端复杂骨折,对于部分病例可达到上述四点要求,而用股骨髁支撑钢板则相对较困难。

【关键词】 股骨远端复杂骨折;髁动力加压钢板;股骨髁上逆向交锁髓内钉;股骨髁支撑钢板

Surgical treatment of complex fracture of distal femur L IU Fa n ,CAI Yuhui ,ZAO J ia n ,et al.Dep art ment of Ort hopaedics ,Affiliated Hospital ,Na ntong University ,Na ntong 226001,CHINA

【Abstract 】　Objective To evaluate the clinical outcomes of the treatment of complex f racture of distal femur by internal fixation with dynamic condylar plates ,GSHN or condylar buttress plates.Methods Thirty six cases with complex f racture of distal femur were treated by operations.There were 9patients with open f racture and 27cases closed f racture.By AO/ASIF classification ,there were 16cases of type A3,9cases of type C2,11cases of type C3.There were 17cases treated with open reduction and internal fixation with dynamic condylar plates ,7cases with internal fixation with GSHN and 12cases with open reduction and internal fixation with condylar buttress plates.From 5to 7days after operation ,all 36cases started to exercise their knee joints gradually with CPM.R esults The mean follow 2up was 2215months (6～43months ).In 36cases ,no infection occurred and no one was ununion.The outcome was evaluated with K olment rating system ,19cases were graded as excel 2lent ,11cases as good ,5cases as fair ,1case as poor ,knee joint f unction was excellent to good in 8313%.Conclusion To get satisfctory clinical effects in treating complex fractures of distal femur by operations ,it must f ulfil several conditions such as getting anatomical reduction ,rigid internal fixation ,trying our best to conserve blood supplying for f racture segments and reducing injury of f ractures and tissues around ,providing the base of relatively early recovery exercise after ing DCS or GSHN to treat complex f racture of distal femur can make some of the cases to f ulfil these four demands ,while condylar buttress plates can not.

【K ey w ords 】 Complex f racture of distal femur ;Dynamic condylar plates ;Green 2Seligson 2Henry intramedullary nail (GSHN );Condylar buttress plates

[J ia ngsu Med J ,J a nuary 2006,32(1):20222.]

作者单位:226001　南通大学附属医院骨科

股骨远端复杂骨折系指股骨下段距关节面15cm 以内的复杂骨折,由于此部位的骨髓腔较宽,多

为松质骨,而且与腘部血管、神经相邻,临床上较多见为多折段多折块的严重粉碎性骨折。故该部位骨折伤情复杂,并发症多,致残率高,是最难治疗的骨折之一[1]。2001年1月～2004年8月,对我院此类

患者采用手术治疗,获得了满意的疗效,现报道如下。

资料与方法

一、一般资料

本组34例,男23例,女11例;年龄23～76岁。36侧骨折(2例为双侧骨折),左16侧,右20侧。AO/ASIF 分类[2]:A3型16侧,C2型9侧,C3型11