髁钢板治疗股骨远端及转子部骨折并发症的临床分析

摘要

Objective　To study the causes of complications of condyle plate for the treatment of intertrochanteric and distal femoral fractures and to discuss its preventive measures.Methods　122 cases of intertrochanteric and distal femoral fractures were treated with condyle plate.Intertrochanteric fractures occurred in 89 cases,of which 22 were associated with upper femoral fracture;The distal femoral fractures occurred in 33 cases and 68 had comminuted fractures.Results　Among the 48 cases of postoperative complications in 75 sites,rotation deformity of lower limb occurred in 13,coxa vara and coxa valga in 11,poor-reduction of lesser trochanter in 7,deformity of knee joint in 7,joint injuries in 2,failure of internal fixed plate in 9,late coxa vara in 5,ankylosis of knee in 11 and delayed union in 10.The main causes of the complications were as follows:Inappropriate selection of the time of operation,poor surgical design,inadequate knowledge of the characteristics and the chief points of the practical use of the condyle plates and the institution of too early weight bearing. Conclusion　Timely operative treatment,using standardized technique and the institution of corrective postoperative functional exercises are important measures to prevent postoperative complications.%目的　探讨髁钢板内固定治疗股骨远端及转子部骨折术后并发症的发生原因,并提出预防措施。方法　采用髁钢板内固定治疗股骨远端及转子部骨折122例,股骨转子部骨折89例(含复合有股骨干上段骨折的转子部骨折22例),股骨远端骨折33例,其中粉碎性骨折68例。结果　发生术后并发症48例,共75处。发生下肢旋转畸形13处,髋内翻和髋外展畸形11处,小转子未复位7处,膝关节畸形7处,打透关节2处,钢板内固定失效9处,晚期髋内翻5处,膝关节僵硬11处和迟缓愈合10处。主要原因是手术时机掌握欠妥,未正确掌握髁钢板的设计特点和应用要领,术后过早下地负重。结论　尽量早期手术,规范手术操作,正确指导术后功能锻炼是预防术后并发症的重要措施。