初步探讨双钢板治疗股骨远端骨折的适应症

发布时间：2018-04-19 16:37

本文选题：股骨远端骨折 + 内外侧双钢板　；参考：《重庆医科大学》2015年硕士论文

【摘要】：目的探讨临床上治疗股骨远端骨折时双钢板的适应症并随访其疗效与并发症。方法2006年3月至2014年4月,我院共手术治疗股骨远端骨折60侧,根据固定方法不同分为外侧锁定钢板组(单钢板组)和内外侧双钢板组(双钢板组),其中单钢板组48侧,男23侧,女25侧,平均年龄为49.0岁；双钢板组12侧,男6侧,女6侧,平均年龄46.0岁。术中完成外侧锁定钢板固定后,常规行膝关节内外翻应力试验,在排除外侧副韧带断裂后,若内翻应力试验阳性,则行双钢板固定。术中根据骨折处缺损情况确定是否植骨。术后常规行止痛、预防伤口感染、预防深静脉血栓形成等处理,术后72小时内开始行患侧膝关节主、被动屈伸功能锻炼。术后随访12月-48月,平均随访15.9个月。随访内容包括：伤口愈合情况、有无骨折复位丢失、骨折愈合情况、有无内固定断裂,术后一年行患肢Kolmert膝关节功能评价。结果所有患者均获随访,单钢板组与双钢板组各有一例患者于术后一年半因其它原因死亡。患者年龄分布情况如下：40岁及以下有21侧,41-50岁有14侧,50岁以上有25侧。单钢板组平均随访时间为15.2月,平均骨折愈合时间为14.3月；双钢板组平均随访时间为18.5月,平均骨折愈合时间为18月,两组的平均骨折愈合时间无显著性差异(p=0.559)。双钢板组的平均手术时间为180分钟,平均术中出血量约为814毫升；单钢板组的平均手术时间为145分钟,平均术中出血量约为513毫升,两组术中出血与手术时间均无显著性差异。双钢板组中C型骨折比例(100%)及术中植骨率(91.7%)均明显高于单钢板组。单钢板组患者中有1例术后出现内固定断裂,行内固定取出+取自体髂骨植骨+外侧解剖钢板内固定术。术后骨折愈合,未再出现内固定断裂、松动。双钢板组中术后无1例出现内固定松动、断裂,亦无骨折复位丢失、膝关节内翻畸形。所有患者伤口均愈合。根据Kolmert评估标准对术后1年时膝关节的功能进行评估,单钢板组优15侧,良24侧,可7侧,差2侧,优良率为81.25%；双钢板组优4侧,良5侧,可2侧,差1侧,优良率为75.0%,两组优良率无显著性差异(p=0.692)。结论外侧锁定钢板固定为治疗股骨远端骨折的常用方法,当外侧钢板固定后,若膝关节内翻应力试验阳性,且排除外侧副韧带断裂,可加用内侧钢板增加骨折的稳定性,避免术后骨折不愈合和膝关节内翻畸形。双钢板固定在手术时间、术中出血、骨折愈合时间、膝关节功能等方面与单钢板固定无显著差异。
[Abstract]:Objective to investigate the indication of double plate in the treatment of distal femur fracture and follow up its curative effect and complication.Methods from March 2006 to April 2014, 60 distal femur fractures were treated in our hospital. According to the fixation methods, 60 sides were divided into two groups: the lateral locking plate group (single plate group) and the internal and external double plate group (double plate group, 48 sides of which were single plate group).The mean age was 49.0 years old in 23 sides of male and 25 sides of female, 12 sides of double plate group, 6 sides of male and 6 sides of female, with an average age of 46.0 years.After the lateral locking plate was fixed during the operation, the internal and external stress test of the knee joint was routinely performed. After the lateral collateral ligament rupture was excluded, if the varus stress test was positive, double plate fixation was performed.The bone graft was determined according to the defect of fracture.The treatment of pain relief, wound infection and deep vein thrombosis were performed. The knee joint was active and passive flexion and extension function exercises were performed within 72 hours after operation.Postoperative follow-up ranged from 12 months to 48 months, with an average follow-up of 15.9 months.The follow-up included wound healing, loss of fracture reduction, fracture healing and internal fixation fracture. The knee joint function of the affected limb was evaluated with Kolmert one year after operation.Results all the patients were followed up. One case of single plate group and one case of double plate group died from other causes one and a half years after operation.The age distribution of the patients was as follows: 21 patients aged 41-50, 14 patients aged 50 or older, 25 patients aged 50 or above.The average follow-up time of the single plate group was 15.2 months, the average fracture healing time was 14.3 months, the average follow-up time of the double plate group was 18.5 months and the average fracture healing time of the two groups was 18 months. There was no significant difference in the average fracture healing time between the two groups.The average operative time of double plate group was 180 minutes, the average intraoperative bleeding was 814 ml, the average operative time of single plate group was 145 minutes and the average intraoperative bleeding was about 513 ml. There was no significant difference between the two groups in intraoperative bleeding and operative time.The ratio of C type fracture and intraoperative bone graft in double plate group was significantly higher than that in single plate group.In one case of single plate group, internal fixation fracture occurred after operation. Internal fixation was performed with external anatomical plate of autogenous iliac bone graft.Fracture healing after operation, no more internal fixation fracture, loosening.In the double plate group, there was no loosening of internal fixation, fracture, loss of fracture reduction and varus deformity of knee joint.All patients were healed.According to the Kolmert evaluation criteria, the knee joint function in the single plate group was excellent in 15 sides, good in 24 sides, fair in 7 sides, poor in 2 sides, the excellent and good rate was 81.25 in the single plate group, excellent in 4 sides, good in 5 sides, fair in 2 sides and poor in 1 side in the double plate group.The excellent and good rate was 75.0. There was no significant difference in the excellent and good rates between the two groups.Conclusion Lateral locking plate fixation is a common method for the treatment of distal femur fracture. If the lateral plate fixation is positive for the varus stress test of the knee joint and the lateral collateral ligament is excluded, the medial plate can be added to increase the stability of the fracture.Avoid nonunion of fracture and varus of knee joint after operation.There was no significant difference between double plate fixation and single plate fixation in operative time, intraoperative bleeding, fracture healing time and knee joint function.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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