逆行髓内钉治疗股骨髁上骨折的疗效分析

目的探讨闭合复位逆行髓内钉固定技术应用于股骨髁上骨折的疗效。方法收集上海市第八人民医院2007年1月至2009年9月收治的89例股骨髁上骨折行闭合复位、逆行髓内钉固定治疗患者的病历资料进行回顾性分析。术后第1天开始进行膝关节CPM功能锻炼，记录所有患者的骨折临床愈合时间及术后膝关节功能恢复情况。结果接受内固定术的时间为人院后的4—11d，中位时间为7d。所有患者均获随访，随访时间15—30个月，中位时间19个月；手术时间45—85min，中位时间65min；术中出血50～200ml，中位出血量120ml。术中及术后均无肺栓塞发生。术后≤4周膝关节活动范围达120。者82例，占92．1％。骨折临床愈合时间为11～20周，中位愈合时间为12．7周。术后12个月膝关节功能优37例、良44例、可8例、差0例，优良率为91．0％（81／89）。有1例术中发生股骨干骨折，更换为更长的髓内钉后顺利固定新的骨折。无感染及骨折不愈合。结论对于股骨髁上骨折，采用闭合复位、逆行髓内钉内固定是一种有效的微创方法，能获得良好的疗效。

Analysis of the treatment of retrograde intramedullary nailing in femoral supracondylar fracture

Objective To explore the effect of surgical treatment of distal femoral shaft fractures with retrograde nailing. Methods From Janurary 2007 to September 2009, 89 cases of distal femoral shaft fractures were surgically treated in our institute with closed reduction and retrograde nailing. The continue passive motion exercise were administered from the first day after operation. The clinical data about time of fracture healing and recovery of knee function were recorded. Results All the patients were followed up to average 19 months （ range, 15-30 months）. The range of motion was more than 120 degrees within 4 weeks postoperative. The average time for fracture healing was 12.7 weeks （range, 11-20 weeks）. The knee function was assessed according to the Knee Surgery Clinical Scoring System. The rates of excellent and good was 91.0%. There was one case of intraoperative femoral shaft fracture. There was no infection and nonunion. Conclusion The surgical treatment of distal femoral shaft fractures with closed reduction and retrograde nailing is an effective and minimally invasive surgery.