股骨远端骨折常见内固定临床应用评价

目的: 评价股骨远端骨折常见内固定临床应用效果。方法: 1998~2003年共收治股骨远端骨折 215例,骨折按AO/ASIF标准分型, A型 112例, B型 20例, C型 83例。分别采用AO角钢板、松质骨拉力螺钉、DCS、GSH及AO股骨髁钢板内固定, 合并股骨内侧骨质压缩粉碎较重者, Ⅰ期大块自体髂骨植骨。结果: 经平均 10 6个月随访, AO角钢板固定组 (12例): 2例内固定折断骨不连, 1例骨畸形愈合; 松质骨拉力螺钉固定组 (20例 ): 骨折全部愈合; DCS固定组 (96例): 2例骨不连, 1例内固定折断; GSH固定组 (20例 ): 1例骨不连、锁钉折断; AO股骨髁钢板固定组 (67例): 2例骨不连。膝关节功能按Merchan评分标准评分, 总优良率 93%。结论: 股骨远端骨折的常见内固定器械, 均不具包容性, 术前应正确判定骨折的类型并选用合适的内固定, 合并股骨内侧骨质压缩粉碎较重者, Ⅰ期大块自体髂骨植骨。这样, 才能有效提高此类骨折的优良率。

Clinical evaluation of internal fixation devices commonly used for distal femoral fractures

Objective:To evaluate the clinical effect of internal fixation devices commonly used for distal femoral fractures.Method:From the year 1998 to 2003,215 cases with distal femoral fractures(112 AO/ASIF type A,20 type B,83 type C)were treated with AO angulated plates,cancellous bone lag screws,dynamic condylar screw (DCS),green seligsen henry(GSH),and AO condylar femoral plates.Primary autogenous large iliac bone grafting was applied in cases with medial femoral bone collapsed or comminuted.Result:Follow-up with an average of 10.6 months was carried out.In AO angulated plates group(12 cases),hardware breakage and nonunion occurred in 2 cases,malunion in 1 case;In cancellous bone lag screws group(20 cases),bone healing obtained in all cases;In DCS group(96 cases),nonunion occurred in 2 cases,hardware breakage in 1 case;In AO condylar femoral plates group(67 cases),nonunion in 2 cases.The excellent and good rate for knee function according to Merchant Scoring system was 93%.Conclusion:In order to improve the cure rate of distal femoral fractures,appropriate internal fixation devices should be determined according to the type of fractures,owing to its incompatibility for all these fractures.For cases with collapsed and comminuted fragments at medial femur,primary autogenous large iliac bone grafting should be carried out.