股骨髁部骨折四种内固定方法的疗效比较

目的对股骨髁部骨折四种内固定方法的疗效进行比较分析,指导临床合理选择和应用。方法自2000年8月~2005年8月,对291例股骨髁部骨折分别应用“L”型髁钢板(LSCP)、动力髁螺钉(DCS)、逆行交锁髓内钉(GSCN)及微创内固定系统(LISS)的疗效进行回顾性比较分析,包括股骨髁上骨折143例和股骨髁间骨折75例。获随访218例,平均随访时间38·6个月(3~58个月)。按AO/OTA分类,A型(关节外骨折)143例,其中A2型80例,A3型63例;C型(完全关节内骨折)75例,其中C2型37例,C3型38例。结果四种内固定方法的骨愈合率及HSS功能评定结果分布有统计学差异(P<0·05)。LISS组的骨愈合率及HSS功能评定优秀结果分布最高,而LSCP组骨愈合率及HSS功能评定优秀结果分布最低。最终所有骨不连患者经翻修后全部获得骨性愈合。结论微创内固定系统在治疗A3、C2及C3型股骨髁部骨折中,较其他内固定方法具有骨愈合率高和功能恢复满意等特点,值得临床推广应用。

A Comparative Analysis of Clinical Results of Four Internal Fixation Methods for Femoral Condylar Fractures

Objective To analyze and compare the outcome of four fixation methods for femoral condylar fractures for the reference of clinical reasonable selection.Methods The clinical results of 291 patients with femoral condylar fractures,including 143 patients with supracondylar femoral fractures and 75 patients with intercondylar femoral fractures, treated respectively with L-shaped condylar plate, DCS, GSCN and LISS-system in our hospital between August 2000 and August 2005 were retrospectively compared and analyzed.Among 291 patients, 218 patients were followed up for 3 to 58 months (average 38.6 months).According to AO/OTA criteria, 80 patients were graded type A2, 63 type A3, 37 type C2 and 38 type C3. Results The statistical results indicated that there were significant difference in bone healing rate and the distribution of HSS evaluation result among the four methods of internal fixation with the highest excellent outcome rate in LISS and the lowest in LSCP. All patients with bone nonunion obtained the bony union eventually by the revision.Conclusion Compared with other internal fixation methods, the LISS has the characteristic of higher rate of bone union and more satisfactory function recovery in the treatment of type A3, type C2 and type C3 femoral condylar fractures deserving application and popularization.