锁定钢板治疗股骨远端骨折的若干问题探讨附八例病例回顾

目的 探讨锁定钢板治疗股骨远端骨折存在的问题。方法 从2007年3月至2010年6月收治的股骨远端新鲜骨折或骨不连患者数据库中选取8例典型患者进行回顾性分析，其中 6例为新鲜骨折,2例为骨不连伴内置物失效。男7例，女1例；年龄37 ～63岁，平均48.5岁。原始骨折按AO分型：32-A1型2例，33-A1型1例,33-A3型1例,33-C2型4例；均为闭合性骨折。6例新鲜骨折患者中，5例采用闭合复位+微创内固定系统(LISS)经皮插入治疗，1例采用开放复位围关节解剖锁定钢板固定;2例骨不连伴内置物失效的患者采用原外侧手术入路切开，取出失效的螺钉和钢板，更换为LISS固定。结果 8例患者术后获平均22.1个月（12 ～ 30个月）随访。锁定钢板固定术后并发症：肥大型骨不连2例，萎缩型骨不连1例，骨折延迟愈合1例，股骨外翻畸形、骨不连1例，深部感染1例。受伤至骨折愈合时间平均为22个月（4 ～ 49个月）。末次随访时膝关节主动活动度为40°～125°，平均81.3°。结论 使用锁定钢板治疗股骨远端骨折时，应充分理解骨折部立和类型，严格掌握锁定钢板固定的原则和指征，否则易出现骨折延迟愈合和骨不连等并发症。

Problems in treatment of distal femoral fracture with locking plate

Objective To discuss problems in the treatment of distal femoral fractures with locking plate. Methods Eight cases of distal femoral fractures or nonunions were selected for the present study from our database who had been treated with locking plate in our hospital between March, 2007 and June,2010. They were 6 acute fractures and 2 nonunions following original implant failure. They were 7 men and one woman, with an average age of 48.5 years (range, 37 to 63 years). According to AO classification, there were 2 cases of type 32-A1, one case of type 33-A1, one case of type 33-A3 and 4 cases of type 33-C2. All were closed fractures. Of the 6 acute fractures, 5 were treated with close reduction and less invssive stabilization system-distal femur (LISS-DF) and one with open reduction and fixation with peri-articular anatomic locking plate. The 2 nonunions were treated with LISS-DF after removal of the failed implants. Results The patients were followed up for 12 to 30 months (average, 22.1 months). The average time from injury to fracture healing was 22 months (range, 4 to 49 months). Range of movement (ROM) of the affected knee was 40° to 125° (average, 81.3°) at the last follow-up.Conclusion Complications like delayed union or nonunion are likely to occur in treatment of distal femoral fractures with locking plate, unless orthopaedic surgeons have a good understanding of the fracture site and types and a great respect for principles and indications of the locking plate fixation.