三种固定方式治疗股骨远端骨折的疗效比较

目的：对股骨远端骨折3种内固定方法的疗效进行比较，指导临床合理选择和应用。方法：自2005年6月～2012年6月，我院共收治并随访股骨远端骨折56例，其中采用动力髁螺钉（DCS）治疗16例、AO股骨髁解剖钢板治疗18例、逆行交锁髓内钉（RIMN）治疗22例。按A0／OTA分类，A型36例；C型20例。对56例患者的骨折并发症、骨愈合率及膝关节HSS功能评分进行比较。结果：术后随访6～36个月，平均为16．4个月。术后6个月随访结果显示3种内固定方法的骨愈合率比较差异有统计学意义（P〈0．05）。RIMN组骨愈合率最高（95．5％），AO股骨髁解剖钢板组骨愈合率最低（77．8％）。采用HSs评分评价膝关节功能，RIMN组的优良率高于DCS组及A0股骨髁解剖钢板组，差异有统计学意义（P〈0．05）。DCS组和A0股骨髁解剖钢板组相比差异无统计学意义。结论：逆行髓内钉治疗股骨远端骨折，较其他内固定方法具有骨折愈合率高和功能恢复满意等特点，是治疗股骨远端骨折的一种有效的方法。

The comparison of three kinds of internal fixation in the treatment of Distal Femoral Fractures

Objective：To compare the difference between three kinds of internal fixation in the treatment of distal femoral fracture for the reference of clinical reasonable selection. Methods： Between June 2005 and June 2012, the clinical results of 56 patients with distal femoral fracture in our hospital were retrospectively compared and analyzed, 16 cases treated with DCS,18 cases with AO anatomical femoral condylar plate and 22 cases with retrograde intramedullary nail（RIMN）. According to AO/OTA criteria,36 patients were graded type A and 20 type C. Complication, the healing rate and the HSS score of three groups were recorded and analyzed. Resuits：All the patients were followed-up for 6 to36 months with a mean period of 16.4 months. The healing rate between three groups showed significant difference and it was the highest in RIMN group, the lowest in AO anatomical femoral condylar plate group（P〈0.05）. The HSS scores were significantly greatest in RIMN group compared with DCS group and AO anatomical femoral condylar plate group（P〈0.05）and there was no significant difference between DCS group and AO anatomical femoral condylar plate group. Conclusion：Retrograde intramedullary nail is the best method among different internal fixation methods. It is an effective therapy for distal femoral fractures.