动力髁螺钉与髁支撑钢板在股骨远端骨折中的应用比较
摘要
[目的]:比较动力髁加压螺钉与髁支撑钢板在股骨远端骨折治疗应用中的临床疗效。
[方法]:将56例股骨远端骨折患者根据应用内固定物不同分为两组,比较两组手术时间、术中出血量、术后引流量、骨折愈合时间、骨折畸形愈合率及膝关节功能优良率,以观察比较两种内固定物的临床治疗效果。
[结果]:按骨折类型两组中各项分别比较,两组病例中A型及C型骨折手术时间比较,均得出P<0.05,差异有显著性;骨折术中出血量分别比较,均得出P<0.05,差异有显著性;骨折术后引流量分别比较,均得出P>0.05,差异无显著性;A型骨折临床愈合时间比较,P<0.05,差异有显著性。C型骨折术后临床愈合时间比较,P>0.05,差异无显著性;术后骨折畸形愈合率分别比较,均得出P>0.05,差异无显著性;术后膝关节功能优良率分别比较,均得出P>0.05,差异无显著性。
[结论]:对于A型骨折动力髁钉在手术时间、术中出血量及术后骨折临床愈合时间上均优于髁支撑钢板,应首先考虑应用。C型骨折治疗中,手术时间及术中出血量,应用动力髁螺钉优于髁支撑钢板,在两者皆可的情况下优先考虑使用动力髁螺钉。但对于C3型骨折,髁支撑钢板可牢靠固定,疗效满意。在股骨远端粉碎型骨折手术中,因骨折端多为松质骨,且较粉碎,应辅以局部一期植骨,促进骨折临床愈合,可获得满意疗效,值得临床推广使用。
Generally distal femur refers to the distal femur within 15 cm, including Supracondylar and femoral condyle. Femoral closer cylindrical distal femur was swelling, "speakers" shape, and was rotating with the ends extending a femoral condyle. Femoral condyle diameter than the diameter of a long, on both sides of the outside diameter of condylar longer. Femoral condyle capsule around the festival, ligament, muscle and tendon attachment, fractures pieces by these organizations pull hard reset, reset difficult to rear a distal femoral and popliteal sciatic nerve arteriovenous serious fracture, can cause injury.
Fractures of the distal femur fracture of the femur as a whole about 5%. Distal femoral fractures more high-energy injury, injury mechanism was considered to be outside the power of flip or spin axial loads, often leads to distal femur related anatomical structures seriously damaged, and three-dimensional plane articular fractures, and more debris is not the size a collapse overturned displacement, serious bone defects, reduction and fixation difficulties, often difficult to achieve anatomical reduction, handling more difficult, more complications, treatment is not always satisfactory.
With CT, DR, MRI, and other imaging equipment used, the complexity of the distal femur fracture diagnosis continuously improved. Surgical treatment of a new and improved method of fixation material development, from the traditional conservative treatment of the transition to a positive surgery. The purpose of surgery is to achieve articular fractures anatomical reduction, and restoration of the axial rotation fracture arranged femoral condyle of the femur and firmly fixed, as well as the early postoperative functional training, quickly restored the function of the knee. Based on the dynamic condylar screw with the support plate in the femur distal femur fractures of the efficacy compared to the treatment of distal femoral fractures to provide certain clinical reference.
Used in this study were followed up for 56 patients, according to different treatment methods were divided into two groups: dynamic condylar screw (DCS) group: 16 males and 9 females cases 21 cases of traffic accidents, fall injury three cases, a pressure injury Cases; two cases of open fractures, closed fractures in 23 cases, with ipsilateral patellar fracture three cases, the ipsilateral tibial plateau fracture two cases, two cases of ipsilateral meniscus injury, and ipsilateral patellar fracture of tibial plateau one case of ipsilateral one case of anterior cruciate ligament injury, brain injury combined two cases, one case of the merger abdominal injuries, one case of spinal fractures; A fracture 16 cases, 9 cases of C-type fracture. Condylar buttress plate (CBP) group: 24 male and female 7 cases; traffic injuries in 26 cases, five cases fall injury; one case of open fractures, and 30 cases closed fracture, with ipsilateral patellar fracture two cases, the ipsilateral tibial plateau fracture and anterior cruciate ligament and meniscus injury four cases, the merger chest injury cases, one case of the merger of other fractures. A fracture in 19 cases, 12 cases of C-type fracture. Fixation material selection Changzhou City Comfort Medical Devices Limited production of dynamic condylar screw compression and femoral condyle support plate; allogeneic bone grafting material Hill Xiaorui Limited production of biological material allogeneic bone. Two patients were given open reduction and dynamic condylar screw condylar buttress plate fixation. Injuries are a time to visit h ~ 2d. Two groups of patients were followed up for 10 to 18 months, with an average of 14 months. In patients after one month, three months, six months, 12 months and 18 months of outpatient review, inspection knee, hip and ankle function, and X-ray photography to observe and judge fracture healing.
The results showed that two groups of patients with primary healing incision, no skin necrosis, and no implant break loose. Case respectively in the two groups A and C fractures time of the surgery, are drawn P <0.05, there were significant differences; fracture bleeding volume comparison, are drawn P <0.05, there were significant differences; fracture of After the drainage respectively comparison, are drawn P> 0.05, the difference was not statistically significant. A-type fracture clinical healing time, P <0.05, the difference was significant. C-type fracture healing time after clinical, P> 0.05, the difference was not statistically significant; after fracture malunion rates were compared were drawn P> 0.05, the difference was not statistically significant; postoperative knee function were relatively good, P were obtained> 0.05, the difference was not statistically significant.
According to the treatment results concluded that the A-type dynamic condylar fracture nail in the operative time, blood loss and postoperative clinical fracture healing time are better than condylar buttress plate, we should first consider the application. C in the treatment of fractures, surgical time and blood loss, superior application of dynamic condylar screw condylar buttress plate, the two could be given priority under the circumstances the use of dynamic condylar screw. But for C3 fracture, condylar buttress plate fixation can be solid, satisfactory outcome.
In comminuted fracture of the distal femur surgery as a result of multiple fractures to end the cancellous bone, and more crushing, should be complemented by a local graft, and promote the healing of fractures, will be satisfied with the effect, it is for clinical use.
[方法]:将56例股骨远端骨折患者根据应用内固定物不同分为两组,比较两组手术时间、术中出血量、术后引流量、骨折愈合时间、骨折畸形愈合率及膝关节功能优良率,以观察比较两种内固定物的临床治疗效果。
[结果]:按骨折类型两组中各项分别比较,两组病例中A型及C型骨折手术时间比较,均得出P<0.05,差异有显著性;骨折术中出血量分别比较,均得出P<0.05,差异有显著性;骨折术后引流量分别比较,均得出P>0.05,差异无显著性;A型骨折临床愈合时间比较,P<0.05,差异有显著性。C型骨折术后临床愈合时间比较,P>0.05,差异无显著性;术后骨折畸形愈合率分别比较,均得出P>0.05,差异无显著性;术后膝关节功能优良率分别比较,均得出P>0.05,差异无显著性。
[结论]:对于A型骨折动力髁钉在手术时间、术中出血量及术后骨折临床愈合时间上均优于髁支撑钢板,应首先考虑应用。C型骨折治疗中,手术时间及术中出血量,应用动力髁螺钉优于髁支撑钢板,在两者皆可的情况下优先考虑使用动力髁螺钉。但对于C3型骨折,髁支撑钢板可牢靠固定,疗效满意。在股骨远端粉碎型骨折手术中,因骨折端多为松质骨,且较粉碎,应辅以局部一期植骨,促进骨折临床愈合,可获得满意疗效,值得临床推广使用。
Generally distal femur refers to the distal femur within 15 cm, including Supracondylar and femoral condyle. Femoral closer cylindrical distal femur was swelling, "speakers" shape, and was rotating with the ends extending a femoral condyle. Femoral condyle diameter than the diameter of a long, on both sides of the outside diameter of condylar longer. Femoral condyle capsule around the festival, ligament, muscle and tendon attachment, fractures pieces by these organizations pull hard reset, reset difficult to rear a distal femoral and popliteal sciatic nerve arteriovenous serious fracture, can cause injury.
Fractures of the distal femur fracture of the femur as a whole about 5%. Distal femoral fractures more high-energy injury, injury mechanism was considered to be outside the power of flip or spin axial loads, often leads to distal femur related anatomical structures seriously damaged, and three-dimensional plane articular fractures, and more debris is not the size a collapse overturned displacement, serious bone defects, reduction and fixation difficulties, often difficult to achieve anatomical reduction, handling more difficult, more complications, treatment is not always satisfactory.
With CT, DR, MRI, and other imaging equipment used, the complexity of the distal femur fracture diagnosis continuously improved. Surgical treatment of a new and improved method of fixation material development, from the traditional conservative treatment of the transition to a positive surgery. The purpose of surgery is to achieve articular fractures anatomical reduction, and restoration of the axial rotation fracture arranged femoral condyle of the femur and firmly fixed, as well as the early postoperative functional training, quickly restored the function of the knee. Based on the dynamic condylar screw with the support plate in the femur distal femur fractures of the efficacy compared to the treatment of distal femoral fractures to provide certain clinical reference.
Used in this study were followed up for 56 patients, according to different treatment methods were divided into two groups: dynamic condylar screw (DCS) group: 16 males and 9 females cases 21 cases of traffic accidents, fall injury three cases, a pressure injury Cases; two cases of open fractures, closed fractures in 23 cases, with ipsilateral patellar fracture three cases, the ipsilateral tibial plateau fracture two cases, two cases of ipsilateral meniscus injury, and ipsilateral patellar fracture of tibial plateau one case of ipsilateral one case of anterior cruciate ligament injury, brain injury combined two cases, one case of the merger abdominal injuries, one case of spinal fractures; A fracture 16 cases, 9 cases of C-type fracture. Condylar buttress plate (CBP) group: 24 male and female 7 cases; traffic injuries in 26 cases, five cases fall injury; one case of open fractures, and 30 cases closed fracture, with ipsilateral patellar fracture two cases, the ipsilateral tibial plateau fracture and anterior cruciate ligament and meniscus injury four cases, the merger chest injury cases, one case of the merger of other fractures. A fracture in 19 cases, 12 cases of C-type fracture. Fixation material selection Changzhou City Comfort Medical Devices Limited production of dynamic condylar screw compression and femoral condyle support plate; allogeneic bone grafting material Hill Xiaorui Limited production of biological material allogeneic bone. Two patients were given open reduction and dynamic condylar screw condylar buttress plate fixation. Injuries are a time to visit h ~ 2d. Two groups of patients were followed up for 10 to 18 months, with an average of 14 months. In patients after one month, three months, six months, 12 months and 18 months of outpatient review, inspection knee, hip and ankle function, and X-ray photography to observe and judge fracture healing.
The results showed that two groups of patients with primary healing incision, no skin necrosis, and no implant break loose. Case respectively in the two groups A and C fractures time of the surgery, are drawn P <0.05, there were significant differences; fracture bleeding volume comparison, are drawn P <0.05, there were significant differences; fracture of After the drainage respectively comparison, are drawn P> 0.05, the difference was not statistically significant. A-type fracture clinical healing time, P <0.05, the difference was significant. C-type fracture healing time after clinical, P> 0.05, the difference was not statistically significant; after fracture malunion rates were compared were drawn P> 0.05, the difference was not statistically significant; postoperative knee function were relatively good, P were obtained> 0.05, the difference was not statistically significant.
According to the treatment results concluded that the A-type dynamic condylar fracture nail in the operative time, blood loss and postoperative clinical fracture healing time are better than condylar buttress plate, we should first consider the application. C in the treatment of fractures, surgical time and blood loss, superior application of dynamic condylar screw condylar buttress plate, the two could be given priority under the circumstances the use of dynamic condylar screw. But for C3 fracture, condylar buttress plate fixation can be solid, satisfactory outcome.
In comminuted fracture of the distal femur surgery as a result of multiple fractures to end the cancellous bone, and more crushing, should be complemented by a local graft, and promote the healing of fractures, will be satisfied with the effect, it is for clinical use.
引文
1、胥少汀,葛宝丰,许印坎主编,实用骨科学,第 3 版.741.
2、吕夫新,仲崇昆,胡义明,等.动力髁部螺钉治疗股骨远端骨折.中华创伤骨科杂志,2002,4:313-314.
3、马庆文,王铁兵,马建民.解剖型钢板植骨下治疗股骨下端复杂粉碎骨折.中华创伤杂志,2004,6:694-695.
4、胥少汀,葛宝丰,许印坎主编,实用骨科学,第 3 版.742.
5、包锦昌,童星杰,刘好源,等.采用骨端钢板治疗股骨远端骨折 58 例报告[J].中国矫形外科杂志,1997,4(4):263.
6、李强一,张秋琴,韩擎天等.股骨远端骨折三种内固定方法生物力 学 比 较 研 究 与 临 床 应 用 [J]. 骨 与 关 节 创 伤 杂志,2001,16(4):276.
7、David L,Helfct,Dean G,Lorch.Retrogade Intramedullarry Nailing of Supra condylar Femoral Fracture[J]. Clin Orthop, 1998,350:80～84.
8、A.Paige Whittle Chapter 47 Fracture of Lower Extermity S[J].Terry Canale edit CampBell,s Operative Orthopaedics(9th edition) Mosby,2119.
9 、 Bolhofner BR,Carmen B,Clifford P.The results of open reduction and internal fixation of distal femur fractures using a biologic(indirect) reduction technique[J]. J Orthop Trauma,1996,10(6):372～377.
10、Ostrum FR,Geel C. Indirect reduction and internal fixation of supra-condylar femur fractures without bone graft[J]. J Orthop Trauma,1995,9(4):278～284.
11 、 Davison BL.Varus collapse of comminuted distal femur fracture after open reduction and internal fixation with a lateral condylar buttress plate[J].Am J Orthop, 2003,32(1):27～30.
12、李永斌 袁华军 何忠.中华创伤骨科杂志,2006,2(8):119～122.
13、舒先涛,许本柯,刘兵.股骨髌骨沟的临床意义.骨与关节损伤杂志,2001,16:43-44.
1、胥少汀,葛宝丰,许印坎主编,实用骨科学,第 3 版.741.
2、Muler ME,Allogwer M , Shneider R, et al, Manul of internal fixation. Berlin Heidelberg New York,Springer.1991;550.
3、邱贵兴主译。长骨骨折内固定图谱。第 1 版。北京:人民卫生出版社,2002;222.
4、StewartMJ, SiskTD, WallaceSL. Fractures of the distal of the femur :acomparison of treatmeat [J]. JboneJointSurg (Am), 1996,48:784.
5 、 Hontzsch D.Distal femoral frature-technical possibilities [J].Kongressbd Dtsch Ges Chir Kongr,2001,118:371~374.
6、Shelukhin NI. Characteristics of differential diagnosis and tactics of treatment of patients with fractures of the condyles of the femur and tibia [J].Vestn khir ImII Grek, 1998, 157:63 ~65.
7 、 Krettekc ,Schandelmaier P,Richter M,et al.Distal femoral fractures [J].Swiss Surg,1998,14:263~278.
8 、 Kregor PJ.Distal femur fractures with complex articular involvement: management by articular exposure andsubmuscularfixation [J]. Orthop Clin Noth Am,2002, 33:153 ~157.
9、Healy WL, Brooker AF Jr. Distal femoral fractures: comparison of open and close methods of treatment [J].ClinOrthop, 1983, 174:166.
10、Schatzker J, Home G, Waddell J. The Toronto experience with the supracondylar fracture of the femur [J].Injury,1974:113.
11、陈正中,马元璋./L0 形加压钢板治疗股骨髁上骨折[J].骨与 关节损伤杂志,1989,4:11.
12、刘树青,胥少汀.股骨髁上骨折槽形角状钢板固定[J].中华外科杂志,1988,26:736.
13、Schatzker J, Mahomed N , Schiffman K, et al. Dynamic condylar screw: a new device [J]. J Orthop Trauma,1989,3:124.
14、Ostrum RF, GeelL. Indirect reduction and internal fixation of supra condylar femur fracture without bonegraft [J].J Orthop Trauma,1995,9:278.
15、Schandelmaier P, Krettek C , Miclau T, et al. Stabilization of Distal Femoral Fractures Using the LISS[J].Techniques Orthopead,1999,14(3):230-246.
16、包锦昌,童星志,刘好源,等.采用骨端钢板治疗股骨远端骨折58 例报告[J].中国矫形外科杂志,1997,4(16):263.
17、 Marks DS,Isbister ES,Dorter KM.Zickel supra condylar nails for the fracture of distal end of the femur [J].ClinOrthop, 1986, 212:77.
18、Shelbourne KD,Brueckmann FR. Rush-pin fixation of supra condylar and inter condylar fracture of he femur [J].J Bone Joint Surg ,1982,64:161.
19、刘大雄,马文学.Ender 钉用于难治性股骨干下段骨折[J].骨 与关节损伤杂志,1991,6:232.
20、章元,单锦.股骨下端髓内/X0 形张力钉的设计与临床应用 [J].骨与关节损伤杂志,1995,10:37.
21、Brooker AF,Brumback RJ. Brooker-wills nails in treatment of intraisthmal injures of the femur [J].J Trauma,1988,28:688.
22、Gellman RE, Paiment GD,Green HD,et al.Treatment of supra condylar femoral fractures with aretrograde intramedullary nails[J].ClinOrthop,1996,332:90.
23、尹峰,黄洪月,印心奇,等.GSH 髁上交锁髓内钉治疗股骨远端粉碎性骨折[J].中国矫形外科杂志,2000,7(10):949.
24、Noer HH,Christensen N.Distal femoral fractures treatment by external fixation with Ortho fix[J]. UgeskerLaeger,1993, 155: 2699.
25、Thomas P.Ruedi,Christoph Sommer. From the classical AO compression plate to the new internal fixator principle[J].Chin J Orthop Trauma, 2003,5(3):212-217.
2、吕夫新,仲崇昆,胡义明,等.动力髁部螺钉治疗股骨远端骨折.中华创伤骨科杂志,2002,4:313-314.
3、马庆文,王铁兵,马建民.解剖型钢板植骨下治疗股骨下端复杂粉碎骨折.中华创伤杂志,2004,6:694-695.
4、胥少汀,葛宝丰,许印坎主编,实用骨科学,第 3 版.742.
5、包锦昌,童星杰,刘好源,等.采用骨端钢板治疗股骨远端骨折 58 例报告[J].中国矫形外科杂志,1997,4(4):263.
6、李强一,张秋琴,韩擎天等.股骨远端骨折三种内固定方法生物力 学 比 较 研 究 与 临 床 应 用 [J]. 骨 与 关 节 创 伤 杂志,2001,16(4):276.
7、David L,Helfct,Dean G,Lorch.Retrogade Intramedullarry Nailing of Supra condylar Femoral Fracture[J]. Clin Orthop, 1998,350:80～84.
8、A.Paige Whittle Chapter 47 Fracture of Lower Extermity S[J].Terry Canale edit CampBell,s Operative Orthopaedics(9th edition) Mosby,2119.
9 、 Bolhofner BR,Carmen B,Clifford P.The results of open reduction and internal fixation of distal femur fractures using a biologic(indirect) reduction technique[J]. J Orthop Trauma,1996,10(6):372～377.
10、Ostrum FR,Geel C. Indirect reduction and internal fixation of supra-condylar femur fractures without bone graft[J]. J Orthop Trauma,1995,9(4):278～284.
11 、 Davison BL.Varus collapse of comminuted distal femur fracture after open reduction and internal fixation with a lateral condylar buttress plate[J].Am J Orthop, 2003,32(1):27～30.
12、李永斌 袁华军 何忠.中华创伤骨科杂志,2006,2(8):119～122.
13、舒先涛,许本柯,刘兵.股骨髌骨沟的临床意义.骨与关节损伤杂志,2001,16:43-44.
1、胥少汀,葛宝丰,许印坎主编,实用骨科学,第 3 版.741.
2、Muler ME,Allogwer M , Shneider R, et al, Manul of internal fixation. Berlin Heidelberg New York,Springer.1991;550.
3、邱贵兴主译。长骨骨折内固定图谱。第 1 版。北京:人民卫生出版社,2002;222.
4、StewartMJ, SiskTD, WallaceSL. Fractures of the distal of the femur :acomparison of treatmeat [J]. JboneJointSurg (Am), 1996,48:784.
5 、 Hontzsch D.Distal femoral frature-technical possibilities [J].Kongressbd Dtsch Ges Chir Kongr,2001,118:371~374.
6、Shelukhin NI. Characteristics of differential diagnosis and tactics of treatment of patients with fractures of the condyles of the femur and tibia [J].Vestn khir ImII Grek, 1998, 157:63 ~65.
7 、 Krettekc ,Schandelmaier P,Richter M,et al.Distal femoral fractures [J].Swiss Surg,1998,14:263~278.
8 、 Kregor PJ.Distal femur fractures with complex articular involvement: management by articular exposure andsubmuscularfixation [J]. Orthop Clin Noth Am,2002, 33:153 ~157.
9、Healy WL, Brooker AF Jr. Distal femoral fractures: comparison of open and close methods of treatment [J].ClinOrthop, 1983, 174:166.
10、Schatzker J, Home G, Waddell J. The Toronto experience with the supracondylar fracture of the femur [J].Injury,1974:113.
11、陈正中,马元璋./L0 形加压钢板治疗股骨髁上骨折[J].骨与 关节损伤杂志,1989,4:11.
12、刘树青,胥少汀.股骨髁上骨折槽形角状钢板固定[J].中华外科杂志,1988,26:736.
13、Schatzker J, Mahomed N , Schiffman K, et al. Dynamic condylar screw: a new device [J]. J Orthop Trauma,1989,3:124.
14、Ostrum RF, GeelL. Indirect reduction and internal fixation of supra condylar femur fracture without bonegraft [J].J Orthop Trauma,1995,9:278.
15、Schandelmaier P, Krettek C , Miclau T, et al. Stabilization of Distal Femoral Fractures Using the LISS[J].Techniques Orthopead,1999,14(3):230-246.
16、包锦昌,童星志,刘好源,等.采用骨端钢板治疗股骨远端骨折58 例报告[J].中国矫形外科杂志,1997,4(16):263.
17、 Marks DS,Isbister ES,Dorter KM.Zickel supra condylar nails for the fracture of distal end of the femur [J].ClinOrthop, 1986, 212:77.
18、Shelbourne KD,Brueckmann FR. Rush-pin fixation of supra condylar and inter condylar fracture of he femur [J].J Bone Joint Surg ,1982,64:161.
19、刘大雄,马文学.Ender 钉用于难治性股骨干下段骨折[J].骨 与关节损伤杂志,1991,6:232.
20、章元,单锦.股骨下端髓内/X0 形张力钉的设计与临床应用 [J].骨与关节损伤杂志,1995,10:37.
21、Brooker AF,Brumback RJ. Brooker-wills nails in treatment of intraisthmal injures of the femur [J].J Trauma,1988,28:688.
22、Gellman RE, Paiment GD,Green HD,et al.Treatment of supra condylar femoral fractures with aretrograde intramedullary nails[J].ClinOrthop,1996,332:90.
23、尹峰,黄洪月,印心奇,等.GSH 髁上交锁髓内钉治疗股骨远端粉碎性骨折[J].中国矫形外科杂志,2000,7(10):949.
24、Noer HH,Christensen N.Distal femoral fractures treatment by external fixation with Ortho fix[J]. UgeskerLaeger,1993, 155: 2699.
25、Thomas P.Ruedi,Christoph Sommer. From the classical AO compression plate to the new internal fixator principle[J].Chin J Orthop Trauma, 2003,5(3):212-217.