锁定加压钢板与逆行髓内钉对股骨远端骨折的疗效分析

摘要

目的：探讨锁定加压钢板与逆行髓内钉对股骨远端骨折的疗效。方法收集2009年4月至2012年4月在荆州市第三人民医院骨科治疗的58例股骨远端骨折临床资料,根据硬币投掷法分为钢板组23例和髓内钉组35例,钢板组采用锁定加压钢板内固定,髓内钉组行逆行髓内钉固定；记录两组患者手术时间、出血量、骨折愈合时间、完全负重时间和术后并发症发生率,并评价两组患者术后膝关节功能恢复情况。结果与钢板组相比,髓内钉组术中出血量显著减少,手术时间、完全负重时间也明显缩短[(381.3±76.8) mL vs (479.5±89.3) mL,(123.2±18.6) min vs (164.7±27.4) min,(9.4±2.6)周 vs(11.4±3.9)周,P<0.05]；按照膝关节Kolment评定标准,髓内钉组优良率显著高于钢板组(88.57% vs 69.57%,P<0.05)。钢板组术后有1例发生切口感染,1例骨折不愈合,2例出现膝关节内翻畸形；髓内钉组切口感染1例,骨折不愈合1例,无膝关节内翻畸形；髓内钉组术后并发症发生率显著低于钢板组(14.29% vs 26.09%,P<0.05)。结论逆行髓内钉在治疗股骨远端骨折时出血量更少,手术时间明显缩短,术后膝关节功能恢复更佳,且并发症发生率也显著降低,值得临床推广。%Objective To explore the clinical curative effect of locking compression plate and retro-grade intramedullary nails in distal femur fractures patients. Methods 58 cases of distal femoral fracture pa-tients clinical data was collected treated in Department of Orthopaedics,the Third People′s Hospital of Jing-zhou City, 2009. 4~2012. 4 ,accorded to the different internal fixation divided into plate group 23 cases and intramedullary nail group 35 cases;plate group taken locking compression plate methods,intramedullary nail group underwent retrograde intramedullary nails. Recorded two groups of patients with operation time, blood loss, fracture healing time, full weight bearing time and the incidence of postoperative complications,and the evaluated of two groups with postoperative knee function recovery. Results Intramedullary nail group opera-tion time,bleeding,time to full weight bearing was significantly less than that of the control group[(381. 3 ± 76. 8) mL vs (479. 5 ± 89. 3) mL, (123. 2 ± 18. 6) min vs (164. 7 ± 27. 4) min,(9. 4 ± 2. 6) w vs(11. 4 ± 3. 9) w,P<0. 05];according to the standard of Kolment, assessment of knee joint, intramedullary nail group was significantly higher than that of steel group(88. 57% vs 69. 57%,P<0. 05). Plate group mainly postoperative incisional infection occurred in 1 cases, 1 cases of nonunion of fracture, 2 cases of varus knee deformity; intramedullary nail group 1 cases of wound infection, nonunion in 1 cases, no knee varus deform-ity;intramedullary nail group the incidence of postoperative complications was significantly lower than that of the control group (14. 29% vs 26. 09%,P <0. 05). Conclusion Retrograde intramedullary nail in the treatment of distal femoral fracture, less blood loss, operation time is shortened obviously, better recovery of knee joint function after operation, and the complication rate was also significantly reduced, and worth the clinical promotion.