锁定钢板治疗膝关节周围骨折或骨不连的并发症分析

目的 探讨锁定钢板治疗膝关节周围 骨折或骨不连的并发症及预防方法。方法 对2005年1月至2009年5月采用锁定钢板治疗并获得随访的97例106侧膝关节周围骨折或骨不连患者资料进行回顾性分析，男62例，女35例；平均年龄34.8岁（18～54岁）。骨折或骨不连部位：股骨远端46侧，胫骨近端60侧。76例85侧为外伤性骨折,21例21侧为骨不连。术后每个月随访，记录患者美国特种外科医院膝关节评分(HSS)和并发症的发生情况。分析不同性别、致伤原因、损伤类型、骨折类型及于术时u等出现并发症的差异性。结果 97例患者术后获平均23.8个月（10 ～ 32个 月）随访。46侧股骨远端骨折或骨不连患者术后1年HSS评分平均为83.4分，有15侧(32.6％)发生并发症。60侧胫骨近端骨折或骨不连患者术后1年HSS评分平均为86.4分，有10侧(16.7％)发生并发症。不同性别、致伤原因、损伤类型及骨折类型之间间 并发症的发生率比较，差异无统计学意义(P＞0.05)；而不同于术时间组间比较，差异有统计学意义(x2=5.440,P=0.015)。结论 锁定钢板固定为微创手术治疗膝关节周围骨折或骨不连提供了一种新的方法,但在其备受推崇的同时也存在一些不足。只有严格掌握其手术适应立证，了解工作原理，才能最大限度地降低并发症的发生率。

Complications following treatment of peri-knee fracture or nonunion by locking plates

ObjectiveTo analyze complications following the treatment of peri-knee fracture or nonunion by locking plates.Methods From January 2005 to May 2009, we used internal fixation with a locking plate to treat 106 closed peri-knee fractures in 97 patients (46 distal femoral fractures and 60 proximal tibia fractures). There were 85 cases of fresh fracture and 21 cases of nonunion. They were 62 males and 35 females, with an average of 34.8 years (from 18 to 54 years). The patients were followed up monthly for The Hospital for Special Surgery (HSS) scores and complications. Analyses were done to find associations between complications and gender, injury cause, injury type, facture type and operation time. ResultsThe follow-ups averaged 23.8 months (from 10 to 32 months ). The 46 distal femoral fractures obtained an average HSS score of 83.4 points one year after operation and had a complication rate of 32.6 ％ ( 15 cases); the 60 proximal tibia fractures obtained an average HSS score of 86. 4 points one year after operation and had a complication rate of 16.7 ％ (10 cases). There were no significant associations between complication rate and gender, injury cause, injury type and fracture type ( P ＞ 0. 05). There was a significant association between complication rate and operation time(x2 = 5.440, P = 0. 015).Conclusions Although locking plates are a new and effective treatment for peri-knee fracture or nonunion, they still have drawbacks. Indications should be strictly followed and care should be taken to avoid postoperative complications as much as possible.