中国修复重建外科杂志

中国修复重建外科杂志

锁定接骨板弹性内固定治疗股骨远端骨折

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目的 探讨锁定接骨板弹性内固定治疗股骨远端骨折的疗效。 方法 2015 年 1 月—2016 年 6 月,采用锁定接骨板弹性内固定治疗股骨远端骨折 21 例。男 5 例,女 16 例;年龄 32~88 岁,平均 62 岁。摔伤 14 例,交通事故伤 5 例,坠落伤 2 例。左侧 13 例,右侧 8 例。闭合性骨折 20 例,开放性骨折 1 例。骨折根据 AO/OTA 分型:33-A1 型 5 例,33-A2 型 3 例,33-A3 型 8 例,33-C2 型 2 例,33-C3 型 3 例。受伤至手术时间 3~13 d,平均 6.5 d。 结果 术后患者切口均Ⅰ期愈合。18 例患者获随访,随访时间 12~24 个月,平均 16 个月。X 线片复查示骨折均愈合,愈合时间 8~24 周,平均 16.6 周;关节面恢复平整,下肢长度恢复。随访期间无螺钉松动、钢板断裂,无膝关节内外翻畸形,未出现明显膝关节僵硬。术后 6、12 个月间 VAS 评分比较,差异无统计学意义(P>0.05);其余各时间点间比较,差异均有统计学意义(P<0.05)。术后 3、6、12 个月膝关节活动度较 1 个月时明显增大,比较差异均有统计学意义(P<0.05);3、6、12 个月间比较,差异均无统计学意义(P>0.05)。各时间点间 Neer 评分比较,差异均有统计学意义(P<0.05);术后 12 个月,按 Neer 评分标准评定膝关节功能,获优 12 例、良 6 例。 结论 锁定接骨板弹性内固定治疗股骨远端骨折临床效果良好,是治疗该类型骨折的有效方法之一。

Objective To analyze the effectiveness of flexible internal fixation with locking plate for distal femoral fractures. Methods Between January 2015 and June 2016, 21 cases of distal femoral fractures were treated. There were 5 males and 16 females with an average age of 62 years (range, 32-88 years). Injury was caused by falling in 14 cases, by traffic accident in 5 cases, and by falling from height in 2 cases. The fractures located at the left side in 13 cases and the right side in 8 cases. Twenty cases were fresh closed fractures and 1 case was open fracture. According to AO/Association for the Study of Internal Fixation (AO/OTA) typing, there were 5 cases of type 33-A1, 3 of type 33-A2, 8 of type 33-A3, 2 of type 33-C2 and 3 of type 33-A3. The time from injury to operation was 3-13 days (mean, 6.5 days). Results All operation incisions healed primarily. Eighteen patients were followed up 12–24 months (mean, 16 months). All fractures healed, and the healing time was 8–24 weeks (mean, 16.6 weeks). The articular surface was smooth and the thigh length was recovered. No screw loosening, plate breakage, valgus or varus of the knee, stiff of the knee or non-unions occurred during follow-up. There was no significant difference in visual analogue scale (VAS) score between 6 and 12 months after operation (P>0.05), and the difference was statistically significant bewteen the other time points (P<0.05). There were significant differences in the range of motion of knee between 1 month and 3, 6 and 12 months (P<0.05); there was no significant difference between 3, 6, and 12 months (P>0.05). There were significant differences in the Neer scores between 1, 3, 6, and 12 months after operation (P<0.05). According to Neer score criteria, the results were excellent in 12 cases and good in 6 cases at 12 months after operation. Conclusion Flexible internal fixation with locking plate for distal femoral fractures can get good functional recovery.

关键词: 股骨远端骨折; 锁定接骨板; 内固定

Key words: Distal femoral fracture; locking plate; internal fixation

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