股骨远端骨折的手术治疗

目的　评价不同内固定材料治疗股骨远端骨折的临床疗效。方法　应用L形髁钢板 ,动力加压钉板 ,股骨远端解剖钢板和逆行股骨髁上交锁髓内钉等 4种内固定材料治疗股骨远端骨折 53例 ,其中随访 1 2个月以上者 44例 (平均随访 1 7月 ) ,采用X线检查及膝关节KSS评分评估治疗结果。结果　本组 44例患者 ,6例骨折对位欠佳 ,5例出现内固定松动、断裂 ,其中 2例发生骨折不愈合 ,无一例发生感染。各内固定组的优良率分别是 ,L形髁钢板 71 4% ,动力加压钉板 1 0 0 % ,解剖钢板 88 9% ,逆行交锁钉 89 5 % ,各组间优良率无显著差异。结论　 4种内固定都能起到较好治疗效果 ,手术适应症选择得当和内固定材料的规范操作是关键。逆行股骨髁上交锁髓内钉适用于粉碎性骨折 ,解剖钢板适用于骨骺未闭合青少年骨折 ,动力加压钉板适用于“T”形和“Y”形骨折 ,L形髁钢板不作为治疗首选 ,可作为其他方法的补充选择

Surgical treatment of distal femoral fracture

Objective To evaluate the clinical results of different internal fixation material for distal femoral fractures Methods 53 cases of distal femoral fractures were treated with L condylar plate,dynamic compression plate and screw and IMSC nail respectively.Among them,44 patients were followed up for at least 12 months(mean:17 months),which included 7 cases treated with L condylar plate,9 cases with dynamic compression plate and screw,and 19 cases with IMSC nail.The clinical results were evaluated through X ray and knee society clinical rating system.Results In these 44 cases,there were 6 slight malunions,5 loosening of and rupture of the internal fixation device and or 3 non unions.There was no infection.Good or excellent results were obtained in 71 4% of fractures with L condylar plate,100% with dynamic compress plate,88 9% and 89 5% with IMSC nails There was no significant difference among these groups.Conclusion Distal fractures can be managed effectively by any one of the four kinds of internal fixation;the key points of success are selecting suitable indications for operations and acting on operation principles.IMSC is suitable for use in comminuted fractures,anatomical plate is recommended for adolescent whomse epiphyseal growth plate closure not yet appeared,Dynamic condylar plate and screw are indicated for Y or T fractures,L blade plate is considered asupplement of other treatment.