逆行交锁髓内钉和股骨髁钢板治疗股骨髁上(间)骨折疗效分析

Condylar-Intercondylar Fractures Treatment with Retrograde Interlocking Intramedullary Nail and Condylar Plate

摘要: 目的：比较逆行交锁髓内钉和股骨髁钢板治疗股骨髁上(间)骨折的疗效，准确掌握各自优点便于选择手术方式。方法：回顾2007年11月至2014年3月在我院收治的股骨髁上(间)骨折82例，其中利用钢板固定40例，逆行交锁髓内钉固定42例。结果：82例患者随访8~24个月，平均14.3个月。两组患者骨折愈合时间分别为5.2 ± 1.76、5.0 ± 1.88个月。两组比较(P = 0.6207 > 0.05)差异无显著意义；手术时间分别为83 ± 21.20 min、67 ± 18.60 min，两组比较(P = 0.0004789 < 0.01)差异有显著意义；术后引流量分别为330 ± 27.43 ml、304 ± 30.10 ml，两组比(P = 0.0003109 < 0.01)差异有显著意义；膝关节功能钢板组小于90˚5例，髓内钉组2例；钢板组钢板断裂3例，感染1例。余病例全部愈合。结论：逆行交锁髓内钉治疗股骨髁间骨折具有操作方便、简单、缩短手术时间、出血少、固定牢固、又能防止骨折端短缩和旋转。为膝关节早期功能活动提供保证与可能。从而预防和减少膝关节功能障碍及并发症的发生率。而股骨髁钢板对于粉碎骨折更有优势。

Abstract: Objective: To compare the effect of retrograde interlocking intramedullary nail(RIM) and condylar plate (CP) which were used by femoral condylar-intercondylar fracture patients, and accurately grasp of their own advantages to facilitate the choice of surgical methods. Method: Retrospecting 82 patients with femoral condylar-intramedullary fracture who accepted operation treatment in my hospital from November of 2007 to March of 2014, forty cases were treated by CP (CP group) and forty-two cases were treated by RIM (RIM group). Result: All cases were followed up, and shortest period was eight months and longest period was twenty-four months, the average period was 14.3 months. Their fracture union time was respectively 5.2 ± 1.76 months, 5.0 ± 1.88 months, there was no significant difference by comparing the two groups (P = 0.6207 > 0.05); their operation times was respectively 83 ± 21.20 min, 67 ± 18.60 min, the comparison of two groups has significant difference (P = 0.0004789 < 0.01). Post-operation flow quantity was respectively 330 ± 27.43 ml, 304 ± 30.10 ml, the comparison of two groups has significant difference (P = 0.0003109 < 0.01). Five cases treated by CP had worst knee joint function which flexion range were less than 90˚ and two cases by RIM; three cases of plate breakage and one case of infection in CP group. The other cases were all union. Conclusion: RIM has more advantages to treat femoral condylar-intercondylar fracture than CP, for example, easy to operate, operation time is short and less blood quantity, firm fixation, especially, it could prevent leg shorten and rotation and allow the knee joint early stage movement. CP is superior to treat the splintered fractures.

文章引用：陈振强, 赵兴伟, 张强, 石建民, 王强, 张宪昆, 孟元. 逆行交锁髓内钉和股骨髁钢板治疗股骨髁上(间)骨折疗效分析[J]. 亚洲外科手术病例研究, 2017, 6(2): 5-11. https://doi.org/10.12677/ACRS.2017.62002

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