三种内固定物治疗股骨远端骨折的稳定性比较

背景：目前，内固定植入物治疗股骨远端骨折的方式有多种，较多使用的方法为锁定加压钢板、顺行髓内钉和逆行髓内钉，临床对这3种固定方法的疗效持不同观点。 目的：通过对股骨远端骨折锁定加压钢板、顺行髓内钉和逆行髓内钉治疗方法的比较，选择合适的内固定方法。 方法：回顾性分析118例股骨远端骨折行内固定治疗患者临床资料，分别采用锁定加压钢板38例，顺行髓内钉21例，逆行髓内钉59例，比较3组内固定植入过程中失血量、手术时间、骨折愈合时间、以及膝关节术后恢复的优良率。 结果与结论：118例患者均获随访，时间为14-26个月，平均为20个月。所有患者未发生感染，1例患者因骨病例骨折导致骨缺失愈合延迟，采用骨填充后在第19周基本完全愈合，其余均在4.5个月内愈合。在骨折愈合时间上3者比较，差异无显著性意义（P 〉 0.05）。术中失血量及手术时间方面，顺行髓内钉组和逆行髓内钉组均优于锁定加压钢板组，顺行髓内钉组要优于逆行髓内钉组，差异有显著性意义（P 〈 0.05）。锁定加压钢板组、顺行髓内钉组及逆行髓内钉组3者膝关节Kolment的评分优良率分别为76.3%，52.4%，86.4%。说明逆行髓内钉内固定牢固，稳定可靠，出血量少，创伤小、骨折易复位等优点，特别在膝关节功能恢复方面表现效果更好，与锁定加压钢板及顺行髓内钉组比较，逆行髓内钉治疗股骨远端骨折更有优势。

Comparison of the stability of three internal fixators for distal femoral fracture

BACKGROUND： There are various internal fixators in treatment of distal femoral fracture. The commonly used fixators are locking compression plate, anterograde intramedullary nails and retrograde intramedullary nails. However, the efficacy of three common fixation is controversial.
OBJECTIVE： To compare the effect of locking compression plate, anterograde intramedullary nails and retrograde intramedullary nails for treatment of distal femoral fracture, and to select the appropriate internal fixation method.
METHODS： From May 2007 to November 2007, 118 patients with distal femoral fractures were treated with internal fixation in the hospital and their clinical data were analyzed retrospectively. Among them, 38 cases received locking compression plate, 21 cases received anterograde intramedullary nails, and 59 cases received retrograde intramedullary nails. The intraoperative blood loss, operative time, fracture healing time and rate of good postoperative recovery of knee joint in three groups were compared.
RESULTS AND CONCLUSION： All the involved 118 patients were followed up for 14-26 months, average 20 months. No patients developed infection. Except one case delayed bone defect healing due to the fractures and was completely healed after bone filling at 19 weeks, the other cases healed within 4.5 months. There was no significant difference in fracture healing time among three groups （P 〉 0.05）. Intraoperative blood loss and operation time in anterograde intramedullary nail group and retrograde intramedullary nail group were superior to locking compression plate group. In addition, anterograde intramedullary nail group was superior to retrograde intramedullary nail group, with significant difference （P 〈 0.05）. Kolment grading fine rate in locking compression plate, anterograde intramedullary nail and retrograde intramedullary nail groups was 76.3%, 52.4% and 76.3% respectively. Retrograde intramedullary nail fixation is firm, stable and reliable, with less intraoperative blood loss, shorter operation time, small trauma, and easy fracture reset, especially in the recovery of knee joint function. Compared with locking compression plate and anterograde intramedullary nail, retrograde intramedullary nailing treatment of distal femoral fractures has more advantages.