闭合复位逆行交锁髓内钉治疗股骨下段骨折疗效分析.docVIP

闭合复位逆行交锁髓内钉治疗股骨下段骨折疗效分析 　 作者：李豫明 李文超 丘青中 常旭东 【关键词】 闭合 摘要：目的：总结临床应用闭合复位逆行交锁髓内钉治疗股骨下段骨折的经验。方法：应用闭合复位自髌韧带处纵形小切口经股骨髁间窝前方插钉行逆行交锁髓内钉内固定治疗股骨下段骨折38例。结果：38例股骨下段骨折全部骨性愈合。骨折愈合的时间平均11周。根据Lysholm膝关功能评分标准［1］进行疗效评定，结果优30例，良6例，一般2例，差0例。优良率为94％。结论：闭合复位逆行交锁髓内钉治疗股骨下段骨折更利于骨折的愈合和膝关节功能的恢复。 关键词：闭合复位；股骨下段骨折；逆行交锁髓内钉；髌韧带切口 Clinical Results or Treatment for Distal Femur Fractures with Close Reduction and Retrograde Intramedullery Interlocking Nails Abstract: Objective: To explore the clinical application and the optium opertion manners of retrograde interlocking intramedullery nail in treating distal femur fractures. Method: Thirty-eight cases of distal femur fractures treated with retrograde intramedullery interlocking nails by using close reduction and nailing it in front of fossa intercondylaris through ligament patellar incision were reviewed. Result: All of 38 cases achieved clinical bone healing by using the times which are 11 weeks on average. The results therapy were excellent in 30,good in 6,fair in 2,poor in 0 according to the Lysholm criteria .The “good”or “excellent” rate is 94%. Conclusion: Use of close reduction and retrograde intramedullery interlocking nails has not only advantages of bone healing but also benefiting the recovery of knee joint functions. Key words：Close reduction;Retrograde intramedullery interlocking nails;Distal femur fractures;Ligament patellar incision 随着交通和工伤事故的增加，股骨下段严重粉碎性骨折明显增多，虽有多种治疗方法，但因该部位的解剖特点，疗效常不满意［2］。髓内钉技术被称之为生物性内固定技术。由于髓内钉固定较为符合人体生理特点，固定牢固确实，近年来应用广泛。由Green、Seligson和Henry三人设计的逆行交锁髓内钉，适应于股骨髁上和髁间以及股骨下段骨折，尤其是股骨髁间粉碎性骨折［3］。我们近年来应用闭合复位逆行交锁髓内钉治疗股骨下段粉碎性骨折38例，获得满意疗效。 1临床资料 1.1一般资料：其中男性30例，女性8例，年龄22～63岁，平均34岁。致伤原因：车祸26例，坠落伤6例，跌伤6例。按AO/ASIF骨折分类标准：A1型6例，A2型10例，A3型4例，B1型4例，B2型6例，C2型4例，C3型4例。 1.2方法：均采用硬膜外麻醉，消毒铺巾后大腿上段用驱血带做止血带，平卧位，膝下垫高，膝关节屈曲成135度位，髌骨下至胫骨结节间正中纵形切口，纵形切开髌韧带，显露股骨髁间窝及前侧，此时可切除部分遮挡视野的关节滑膜，于髁间窝前侧0.5～1.0cm处,用骨锥刺孔,由小到大选择扩髓器逆行扩髓［4］，尽可能根据术前X片显示的骨折移位情况试探将扩髓器扩至骨折近端，并最终将主钉插入骨折近端，如不成功，可在C臂X光机透视下扩至骨折近端。选择比扩髓最大型号扩髓器小1 mm的主钉自髁间插入骨折近端，对骨折进行复位固定。先锁骨折远端的两枚