微创内固定系统与小切口复位逆行髓内钉治疗股骨远端骨折疗效比较

目的：比较微创内固定系统（LISS）和小切口复位逆行交锁髓内钉（RIN）内固定方法治疗股骨远端骨折的效果,指导临床合理选择和应用。方法：回顾分析2005年1月—2009年12月治疗的54例股骨远端骨折病例的临床资料。按手术方式分组统计受伤至手术时间、手术时间、术中出血量、骨折愈合时间、并发症、膝关节功能。结果：所有病例获得4~48个月随防,平均15个月。LISS组平均手术时间1.2h（1.0~1.5）h。术中出血量260mL（150~400）mL,骨折愈合时间平均2.5个月（2~3.5）个月,发生并发症3例,发生率为15.8%。RIN组：手术时间1.4h（1.0~2.0）h。术中出血量平均280mL（200~450）mL,平均骨折愈合时间3.0个月（2.0~5.0）个月,发生并发症8例,发生率22.9%。根据美国特种外科医院膝关节功能评分法（HSS）,LISS组：优12例,良5例,中2例,差0例,优良率为89.5%。RIN组：优21例,良6例,中4例,差4例,优良率为77.1%,两组膝关节功能有显著差异（P〈0.05）。结论：LISS及RIN均是治疗股骨远端骨折的微创方法,但对于C型骨折,LISS疗效优于逆行交锁髓内钉固定。

Comparison of the Efficacy of Less Invasive Stabilization System and Retrograde Intramedullary Nail in the Treatment of the Distal Femur Fractures

Objective：To analyze and compare the outcome of two fixion methods,less invasive stabilization system（LISS） and retrograde intramedullary nail（RIN）,in the treatment of distal femur fractures.Methods： The clinical data of 54 patients with distal femur fractures from January 2005 to December 2009 were analyzed retrospectively.The perioperation time,operation time,blood loss during surgery,union time,complication and function of knee were analyzed between two groups.Results： All cases were followed for 4-48 monthes,mean 15 monthes.In LISS fixation group,mean operation time was 1.2 hours（1.0-1.5 hours）,mean blood loss during surgery was 280mL（200-450 mL）and mean union time was 2.5 monthes（2.0-3.5monthes）.Three cases suffered complications（rate 15.8%）.In RIN fixation group,mean operation time was 1.4 hours（1.0-2.0 hours）,mean blood loss was 120mL（100-250 mL） and mean union time was 3.0 monthes（2.0-5.0monthes）.Eight cases suffered complications（rate 22.9%）.The hospital for special surgery knee rating scale system（HSS） was used to evaluate knee function with 100 scores as full marks.There were excellent 12,good 5,middle 2 and fair 3 in LISS group;excellent 21,good 6,middle 4 and fair 4 in RIN group.The excellent and good rate of LISS fixation group were significantly greater than RIN fixation group（89.5% versus 77.1%,P0.05）.Conclusion： LISS and RIN are both suitable for minimally invasive treatment of distal femur fractures.But for C-type fractures,LISS is better than the RIN.