三种内固定方法治疗股骨远端骨折的疗效分析

目的 评价AO角钢板、动力髁螺钉和逆行交锁髓内钉治疗股骨远端骨折的临床疗效.方法 回顾性研究1995年1月至2006年1月手术内固定治疗且获得完整随访的92例股骨远端骨折患者,其中男39例,女53例;年龄31～68岁,平均53.6岁.根据内固定方式分为三组:AO角钢板固定组(n=22)、动力髁螺钉固定组(n=29)、逆行交锁髓内钉固定组(n=41).比较三组患者手术时间、术中出血量、骨折愈合时间,并采用Kolment疗效标准评价结果.结果 随访时间12～36个月,平均18个月.除1例在骨折局部应用骨水泥患者在4个月内末愈合外,其余所有患者均在4个月内骨折愈合;1例逆行交锁髓内钉病例在术后6个月时发牛再骨折.三组患者在骨折愈合时间方面差异无统计学意义(P>0.05).在手术时间、出血量和功能评价方面逆行交锁髓内钉组均明显优于其他两组,差异有统计学意义(P<0.05).结论 逆行交锁髓内钉定位准确、固定牢靠,相对钢板固定具有手术时间短、出血少、创伤小、易复位、骨折愈合率高、关节及肌肉功能恢复快等优点,对治疗股骨远端骨折有明显优势.

Clinical analysis of three internal fixators for femoral fractures

Objective To evaluate clinical effects of 95°angled blade plate(ABP),dynamic condylar screw(DCS)and retrograde intramedullary nail(RIN)used in intemal fixation for distal femoral fractures. Methods Ninety-two cases of distal femoral fractures were included in this study.Their age ranged from 31 to 68 years,with an average of 53.6 years.Of them,22 were treated with 95°ABP,29 with DCS and 41 with RIN.Their functional and radiographic outcomes were collected to compare the differences in bone union time,operation time,intra-operative blood loss,and functional scores according to Kolment rating system. Results They were followed up for 12 to 36 (average,18)months.There was no significant difference in bone union time among the 3 groups(P>0.05),but a significant difference in operation time,intra-operative blood loss and functional scores in favor of RIN(P<0.05).X-ray films showed all fractures got united within 4 months except one case that had used bone cement at fracture site.Refracture occurred 6months postoperatively in ODe patient treated with RIN. Conclusion RIN is superior to the other two fixatom for distal femoral fractures because of advantages of short operative time,less iatrogenic trauma,convenient reduction and rigid fixation.