带锁髓内钉固定股骨干骨折术后膝关节功能障碍原因分析及预防

目的:探讨股骨干骨折行带锁髓内钉固定术后发生膝关节功能障碍的原因及其防治措施.方法:2000年2月至2004年10月间,本科采用带锁髓内钉治疗股骨干上段、中段骨折126例,其中动力型固定6例,静力型固定120例,使用瞄准装置安放远端锁钉,其中A组64例为常规手术自然恢复,B组56例采用综合措施作用于术中及术后,记录术后膝关节功能障碍的各种表现,恢复屈膝达120°的时间,比较两组术后3个月膝关节功能评分(the hospital for special surgery knee rating scale,HSS) 情况.结果:动力型固定6例术后无膝关节疼痛、屈膝受限等表现,静力型固定120例都有不同程度的膝关节功能障碍表现,B组病例的发生率和程度低于A组(P＜0.05),恢复屈膝达120°的时间短于A组(P＜0.05),膝关节功能评分高于A组(P＜0.05).结论:股骨带锁髓内钉远端瞄准器定位杆的操作过程,是造成术后膝关节功能障碍的主要原因,通过采取综合预防措施可明显减轻这些不良影响,有利于膝关节功能早期恢复,促进骨折的愈合.

The Causes and Prevention of Postoperative Knee Joint Dysfunction Following Interlocking Intramedullary Nailing of Femoral Shaft Fracture

Objective:To explore the causes and prevention of postoperative knee joint dysfunction following interlocking intramedullary nailing of femoral shaft fractures.Methods: between February 2000 and October 2004,126 cases of upper and middle femoral shaft fractures were treated with interlocking intramedullary nailing,including 6 cases with dynamic fixation and 120 cases static fixation.The distal locking nails were set by the use of target device.The patients were divided into two groups,where group A(n=64) received conventional operation and underwent spontaneous recovery and group B(n=56) were intervened with comprehensive measures during and after operation.Manifestations of postoperative knee joint dysfunction as well as time to achieving 120-degree flexion were recorded and hospital for special surgery knee rating scale(HSS) at three months post-operation was compared between the two groups.Results: none of the 6 cases treated with dynamic fixation experienced knee-joint pain or restricted flexion,whereas 120 cases treated with static fixation had varied degrees of knee joint dysfunction after operation.Compared with group A,group B showed lower incidence and severity of knee joint dysfunction(P<0.05),shorter duration to achieving 120-degree flexion(P<0.05) and higher HSS(P<0.05).Conclusion: manipulation of the locating shaft on the distal target device for femoral interlocking intramedullary nailing was primary cause of postoperative knee joint dysfunction.Comprehensive preventive measures may significantly ameliorate these adverse effects,benefiting early functional recovery and healing of the fractures.