逆行交锁髓内钉在股骨远端骨折应用.docVIP

逆行交锁髓内钉在股骨远端骨折应用【摘要】目的评价股骨逆行交锁髓内钉的治疗效果。方法自2003年7月起，共收治股骨下段骨折患者31例 (AO分类A1型8例，A2型16例，A3型7例)，行股骨下段骨折开放或闭合复位，逆行交锁髓内钉内固定术，术后随访2～36个月，平均10个月。结果31例中29例获骨性愈合，2例固定术后不足3个月，无法评价，愈合率为93.5%，膝关节功能按Schatzker评分，优15例，良16例，无明显功能丧失。结论逆行股骨交锁髓内钉治疗股骨下段骨折具有并发症少，愈合率高等特点。 【关键词】股骨下段骨折；逆行股骨交锁髓内钉；内固定术 Retrograde intramedullary nailing in distal femoral fractures-results in a series of 31 consecutive operationsLIU Lie-Bin，CHEN Qiang，ZHAOJia-an，et al Zhongshan Torch Hi-tech Industrial Development Zone Hospital，Guangdong 528437，Chian 【Abstract】 ObjectiveThe purpose of this study was to evaluate the therapeutic efficacy of retrograde intramedullary nailing. MethodA series of 31 consecutive patients with 31distal femoral fractures (AO type: type A1 8 cases, type A2 16 cases, type A3 7 cases), who were treated with a retrograde intramedullary nailing. Operational data, per- and post-operative complications and the outcome were studied retrospectively after a mean follow-up of 10 months. Results29 in the 31 cases achieved bone union, and the final union rate was 93.5%. According to Schatzker Scoring system, functions of knees of 15 cases were excellent, 16 cases were good, and none has evident functional incapacitation.ConclusionThe results suggest that the retrograde intramedullary nailing is a reliable alternative in distal femoral fracture treatment with a low complication and high union rate. 【Key words】Distal femoral fracture; Retrograde intramedullary nailing; Internal fixation. 股骨远端骨折为近关节或累及关节面的骨折， 包括股骨下1/3骨折和股骨髁上、髁部骨折；因其骨皮质薄，髓腔大，松质骨多，距膝关节较近等，治疗较为棘手。手术治疗因其能获得解剖复位、早期功能锻炼和负重而得到广泛的共识。之前，股骨髁螺钉和钢板在临床上应用广泛，然而并发症尤其是感染率较高[1-5]。逆行交锁髓内钉（Retrograde intramedullary nailing）即是针对此种情况而发展。我院自2003年7月至2007 年1月应用逆行交锁髓内钉治疗股骨远端骨折31 例，经6个月～2 年随访，疗效满意，现报告如下。 1资料和方法 1.1临床资料本组31例， 男19例， 女12例；均为单侧，右17例，左14例；年龄约19～65岁，平均35.3岁。其中车祸伤26例， 高处坠落伤3例，其他2例；闭合性骨折28例， 开放性骨折3例；骨折分别距膝关节面6～19 cm，平均8.3 cm。 1.2骨折分类开放性骨折按Gustilo分类，Ⅰ度2例，Ⅱ度1例；骨折按AO分类:均为A类，A1型8例，A2 型16例，A3型7例。受伤到手术时间3～12d，平均5.5 d。 1.3材料采用美国stryk