股骨远端复杂骨折的手术治疗

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1、·20·江苏医药2006年1月第32卷第1期JiangsuMedJ,January2006,Vol32,No.1·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

2、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Kolment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

3、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SurgicaltreatmentofcomplexfractureofdistalfemurLIUFan,CAIYuhui,ZAOJian,etal.DepartmentofOrthopaedics,AffiliatedHospital,NantongUniversity,Nantong226001,CHINA【Abstract】ObjectiveToeval

4、uatetheclinicaloutcomesofthetreatmentofcomplexfractureofdistalfemurbyinternalfixationwithdynamiccondylarplates,GSHNorcondylarbuttressplates.MethodsThirtysixcaseswithcomplexfractureofdistalfemurweretreatedbyoperations.Therewere9patientswithopenfracture

5、and27casesclosedfracture.ByAO/ASIFclassification,therewere16casesoftypeA3,9casesoftypeC2,11casesoftypeC3.Therewere17casestreatedwithopenreductionandinternalfixationwithdynamiccondylarplates,7caseswithinternalfixationwithGSHNand12caseswithopenreduction

6、andinternalfixationwithcondylarbuttressplates.From5to7daysafteroperation,all36casesstartedtoexercisetheirkneejointsgraduallywithCPM.ResultsThemeanfollow2upwas2215months(6～43months).In36cases,noinfectionoccurredandnoonewasununion.Theoutcomewasevaluated

7、withKolmentratingsystem,19casesweregradedasexcel2lent,11casesasgood,5casesasfair,1caseaspoor,kneejointfunctionwasexcellenttogoodin8313%.ConclusionTogetsatisfctoryclinicaleffectsintreatingcomplexfracturesofdistalfemurbyoperations,itmustfulfilseveralcon

8、ditionssuchasgettinganatomicalreduction,rigidinternalfixation,tryingourbesttoconservebloodsupplyingforfracturesegmentsandreducinginjuryoffracturesandtissuesaround,providingthebaseofrelativelyearlyrecoveryexerciseafteroperations.UsingDCSorGSHNt