顺行交锁髓内钉治疗股骨远中段双骨折的解剖与临床

目的：研究股骨远中段双骨折的特殊解剖结构，探讨顺行交锁髓内钉内固定治疗此类骨折的适用范围和临床疗效。方法：在X线片和股骨标本上测量股骨髁间窝高度，估算髓内钉尖在股骨远端能到达的最远距离。采用顺行带锁髓内钉内固定股骨远中段双骨折11例，术后2～8周在支具保护下开始膝关节屈伸锻炼。结果：测量发现股骨髁间窝高约6～9mm，髓内钉尖端距内外髁远端水平面2cm为安全距离，不会损伤髌股关节面。11例骨折均达到解剖复位，愈合良好，愈合时间平均5．7个月，下肢功能恢复优4例、良5例、可2例，优良率81．8％。结论：顺行带锁髓内钉治疗股骨远中段双骨折具有固定范围广且可靠、骨折愈合时间短、关节功能恢复好等优点，但也有远端锁钉置入困难之缺点。

Anatomic Observation and Clinical Use of Anterograde Interlocking Intramedullary Nail to Treat Femoral Double Fracture in Distal and Middle Piece

jective:To investigate the special anatomtic structure of femoral double fracture in distal and middle piece, and to explore the indication and therapeutic effect of anterograde interlocking intramedullary nail in treatment of this kind of fracture. Methods:The height of the femoral intercondylar fossa was measured under X ray and in the specimen. The farthest distance to the distal femur of the nail tip was estimated. 11 cases of femoral double fracture in distal and middle piece were freated with internal fixation by anterograde interlocking intermedullary nail. The patients began functional exercise under the protection of orthosis 2 ~ 8 weeks later. Results: The mean height of the femoral intercondylar fossa was about 6 ~ 9mm. 2cm of the nail tip above the distal femoral transverse plane was the safe distance and the joint surface between the femur and whirbone would not be injured. All the fractures in the 11 cases attained the anatomic replacement and excellent healing. The average healing time was 5.7 months. The recovery of function was excellent in 4 cases, good in 5 cases and not bad in 2 cases. Conclusion: The therapeutic application of anterograde interlocking intramedullary nail to femoral double fracture in distal and middle piece have many merits, such as wide scope of fixation, short healing time, good recovery of function, reliable fixation, et al. However, the difficulty in distal locking is the flaw.