影响股骨远端关节内粉碎性骨折手术疗效的因素

目的探讨影响股骨远端关节内粉碎性骨折手术疗效的因素。方法2000年1月至2006年12月，手术治疗股骨远端关节内粉碎性骨折患者119例121侧，男62例63侧，女57例58侧；年龄16～85岁，平均43．1岁。AO分型：B3型15侧，C1型42侧，C2型37侧，C3型27侧。皮肤软组织损伤严重的患者，采用闭合复位＋外固定器固定；开放复位采用髌骨旁切口，显露股骨远端及其关节面，先进行股骨关节面的复位，用克氏针或拉力螺钉固定，然后矫正股骨成角、短缩和旋转畸形，最后选择合适的内固定进行固定。7例7侧采用闭合复位＋外固定器固定；114侧采用开放复位，其中5侧使用外固定器，11侧使用克氏针螺钉固定，8侧使用“T”或“L”形钢板，21侧使用髓内钉系统，37侧使用股骨髁钢板，32侧使用动力髁钢板。术后进行Neer膝关节功能评分和膝关节活动度测量。结果随访时间7—78个月，平均29个月。术后感染4侧。患肢术后膝关节活动度10°～140°，平均109°；Neer评分41—100分，平均63．7分，患肢49侧（40．5％）为优，36侧（29．8％）为良，25侧（20．7％）为可，11侧（9．1％）为差，优良率为70．3％。其中B3和C3型的评分分别为（56．3±15．9）分和（52．14-20．3）分，明显低于C1和C2型的（70．3±16．5）分和（67．7±18．7）分（t=4．6，P〈0．05）。股骨髁钢板内固定组和动力髁钢板内固定组（开放复位）的疗效优于外固定器固定组（闭合复位和开放复位）（t=3．9，P〈0．05）。结论股骨远端关节内粉碎性骨折的类型、不同手术方式是影响术后患肢关节功能的重要因素。

Surgical treatment of intra-articular comminuted fractures of distal femur

Objective To explore the surgical procedures and curative effects for the intra-articular comminuted fractures of distal femur. Methods Totally 119 patients （62 males and 57 females; aged 16 -85 years, mean 43.1 years） with 121 surgically operations for the intra-artieular comminuted fractures of distal femur were followed up. A parapatella approach incision was adopted. Distal femur and auricular surface were exposured. Articular fracture fragments were reduced and Iemporally fixed at first, and then the femural deformities of anglation, shortness, and rotation were corrected. 7 fractures were close reduced and fixed with external fixators. 114 fractures were open reduced, 5 with external fixator, 11 fractures were fixed with simple internal fixation, 8 with ＂T＂ or ＂L＂ shaped plate, 21 with intramedullary nailing, 37 with femur condylar shaped plates, 32 with dynamic condylar screw fixation. Finally proper internal implants were chosen and fixed. Results Four past-operative infections were recorded. The range of the motion （ROM） of the injuried knees was 10° -140°（average 109°.） Neer scores in the injured legs were 41 -100 （average 63.7）. The rate of ＂good and excellent＂ reached 70. 3%. The Neer scores were significant less in complicated fractures （type B3 and C3） than simple fractures （type C1 and C2） （t =4. 6, P 〈0. 05）. The therapeutic effect was significant better in the fractures which were fixed with femur condylar shaped plates and dynamic condylar screws than that with external fixators （ t = 3.9, P 〈 0. 05 ）. Conclusion The reduction results of the femoral intra-articular comminuted fractures directly influence the functional recovery of the injured legs. Articular fracture fragments should be first anatomically reduced, followed by the restoration of the axis, length and rotation of the legs.