股骨远端骨折的分型和治疗

·临床论著·股骨远端骨折的分型和治疗

许伟华　杨述华　杜靖远　肖宝钧　李进　杨操

【摘要】　目的　分析股骨远端骨折的分型和治疗。　方法　回顾性总结1995-2003年间的

603例股骨远端骨折患者,男301例,女302例;年龄0.6～85岁,平均42.6岁。根据Müller分型,

A型282例,B型98例,C型223例;开放性骨折58例(9.6%)。非手术治疗134例,手术治疗469

例。结果　股骨远端A、B和C型骨折治疗后Neer评分依次降低,分别为73.4±13.9、64.9±14.7

和59.2±14.8;手术治疗组Neer评分明显优于非手术治疗组。B型骨折中单纯性骨折和粉碎性骨

折的治疗和预后有较大区别。　结论　股骨远端骨折应根据不同类型而采用不同的手术和内固

定方法治疗,其中B型骨折应以骨折的累及范围和粉碎程度分为三种亚型,选择相应的内固定方

法更为合理。

【关键词】　股骨骨折;　骨折固定术;　骨折分型

C l a ssi f i ca ti on and trea t m en t of d ist a l fe m ora l fractures XU W ei2hua,YAN G Shu2hua,DU J ing2

yuan,X I AO B ao2j un,L I J in,YAN G Cao.D epart m ent of O rthopaedics,U nion Hospital,Tongji M edical

College,Huazhong U niversity of Science and Technology,W uhan430022,China

【Abstract】　O bjecti ve　To analyze the classificati on of distal fe mur fractures and understand the

choice of treat m ent according t o the classificati on.　M ethods　A retr os pective study was carried out in

603cases(301males and302fe males,with age range of0.6285years,average42.6years)with distal

fe mur fractures treated fr om1995t o2003.According t o the Müller classificati on,there were282cases of

type A fractures,98type B and223type C.Fifty2eight cases(9.6%)were with open fractures.Of all,

134fractures were treated by conservative methods,469by surgical operati on,18by comp ressi on p lates,

15by“T”2or“L”2shaped p lates,74by fe moral condylar blade p lates,112by dynam ic condylar

scre w,97by fe moral condylar p lates,23by fe moral l ocked nails,41by distal femoral nails,55by exter2

nal fixat ors and34by others.　Results　The average Neer scores of type A,B and C fractures were de2

creased t o73.4±13.9,64.9±14.7and59.2±14.8res pectively.The average Neer score of surgery

was significantly better than that of conservative methods.There existed marked differences in treat m ent

and p r ognosis bet w een the si m p le and comm inuted fractures in type B fractures.　Conclusi on s　D istal

fe mur fractures should be treated according t o fracture classificati on.Based on the involved areas and

comm inuti on degrees,type B fractures should be gr ouped int o three subtypes that then can be treated by

suitable fixati on method.

【Key words】　Fe moral fractures;　Fracture fixati on;　Fracture classificati on

过去的几年中,我国骨科得到了快速发展,无论是在手术技术,还是内固定材料和种类等方面均经历了巨大的变化。由于股骨远端骨折损伤类型复杂,治疗方法多变,没有一种治疗方法可通用于所有类型的骨折。笔者回顾性总结了1995-2003年间603例股骨远端骨折患者,分析股骨远端骨折不同类型和治疗方法的特点。

1　临床资料与方法

1995-2003年间我院共诊治股骨远端骨折603例,其中男301例,女302例;年龄0.6～85岁,平均

作者单位:430022　武汉,华中科技大学同济医学院附属协和医院骨科

42.6岁。其中骨骺未闭合者21例(3.5%)。左侧305例,右侧286例,双侧12例。根据Müller分型[1],A型骨折282例(46.8%),B型98例(16.3%),C型223例(37.0%)。开放性骨折58例(9.6%);合并神经血管损伤者32例(5.3%)。非手术治疗(牵引+石膏或小夹板固定)134例(22.2%);手术治疗469例(77.8%),其中加压钢板18例(3.0%),“T”或“L”形钢板15例(2.5%),股骨髁角钢板74例(12.3%),动力髁螺钉112例(18.6%),股骨髁钢板97例(16.1%),股骨交锁髓内钉23例(3.8%),股骨远端髓内钉41例(6.8%),外固定器55例(9.1%),其他包括克氏