有限内固定结合骨外固定器治疗股骨下段畸形

目的：探讨内外结合固定在股骨下段畸形治疗中的优势和对术后膝关节屈伸功能的影响。方法：回顾性分析2004年6月至2009年6月治疗的股骨下段畸形患者共38例,男19例,女19例;年龄14～58岁,平均26岁;膝外翻6例,股骨下段内翻4例,内翻伴旋转畸形2例,膝反屈3例,屈膝畸形23例。均采用股骨髁上截骨钢板内固定结合组合式外固定进行治疗,治疗结束后,采用改良的Dimeglio临床评价标准进行膝关节功能评价。结果：38例均获随访,时间6～48个月,平均23个月。所有病例股骨下段畸形获满意矫正,未发生膝关节活动受限、畸形矫正不足、过度和截骨端移位、内固定松动、断裂等并发症。膝关节功能优19例,良12例,可5例,差2例。结论：股骨髁上截骨采用有限内固定结合骨外固定器治疗股骨下段畸形是一种安全有效的治疗方法,克服了单纯使用内固定或外固定的缺点,并将二者的优点相结合,有效地避免了术后膝关节屈伸功能障碍的发生,取得了良好的临床效果。

Limited internal fixation combined with external fixation for the treatment of deformity of the distal end of femur

Objective: To study therapeutic effects of limited internal fixation combined with external fixation in the treatment of deformity of distal end of femur,as well as to explore its effect on the function of knee joint. Methods: From June 2004 to June 2009,38 patients with deformity of distal end of femur were treated with osteotomy at femoral supracondylar and internal fixation combined with hybrid external fixator. Among the patients,19 patients were male and 19 patients were female,ranging in age from 14 to 58 years,with an average of 26 years. Six patients had genu valgum,4 patients had varus of the distal end of femur,2 patients had varus combined with rotation deformity,3 patients had genu recurvation and 23 patients had deformity of genuflex. The function of knee joint was evaluated according to Dimeglio clinical assessment after the treatment. Results: All the patients were followed up and the during ranged from 6 to 48 months,with a mean period of 23 months. All the deformity obtained satisfactory correction,without complications such as limitation of motion of the knee joint,under correction or over correction,displacement of the section of the osteotomy,internal fixation loosening and fracture. Nineteen patients got an excellent result,12 good,5 poor and 2 bad. Conclusion: Supracondylar femoral osteotomy and internal fixation combined with hybrid external fixator is a safe and effective surgery for the treatment of deformity of distal end of femur. This method combines the advantages of internal fixation and external fixation.