微创内外侧双钢板内固定治疗C3型股骨远端骨折

目的探讨采用微创内外侧切口双钢板内固定治疗C3型股骨远端骨折的临床疗效。方法对2009年3月~2012年12月采用微创内外侧切口双钢板内固定治疗C3型股骨远端骨折25例患者进行回顾性分析,包括:记录手术时间,术中出血量,手术并发症,骨折愈合时间,内固定失效,及末次随访膝关节功能。结果手术时间110~150分钟,平均125分钟;术中出血量400~600ml,平均480ml。术后伤口无感染、皮肤坏死发生,均Ⅰ期愈合。25例均获得随访,随访时间12~36个月,平均25个月。X线显示平均术后6个月骨折愈合,无内固定物断裂及松动事件发生。22例患者达到骨折解剖复位。患者末次随访时,2例开放性骨缺损患者关节僵硬(0~50°),其他患者膝关节平均活动范围为2~120°。膝关节功能采用美国特种外科医院膝关节评分标准,优9例,良11例,可3例,差2例,优良率80%。结论采用微创内外侧切口双钢板内固定治疗股骨远端C3型骨折,能较好的暴露骨折,达到骨折内固定的坚强固定,满足早期功能锻炼的要求。微创操作减少了软组织并发症,利于骨折愈合。

Using Double-Plating for type C3 distal femoral fractures via less-invasive combined medial and lateral approaches

Objective To investigate the efficacy of Double-Plating fixation via less-invasive combinedmedial and lateralapproaches in the treatment of type C3 distal femoral fractures. Methods The clinical and radiological data of 25 cases oftype C3 distal femoral fracture fromMarch 2009 to December 2012 were analyzed retrospectively, including the durationtime of operation, blood lost, operation complications, fracture healing time, inter fixation failures and knee joint functionat final follow-up. Results The operation time was from 110 to 150min with an average of 125 min, the blood lost was400 to 600ml with an average of 480ml. Postoperative all wound were stage Ⅰ healing, no infection and skin necrosis.All patients were followed up from12 to 36 months（mean 25 months）. The mean bone healing time was 6 months postoperativelyconfirmed by X-RAY. No implants breaking and loosing occurred. At final follow-up, 2 patients have jointsstiffness （0 to 50°）, the rest patients’Mean arc of knee joint motion was from2 to 100°. According to the hospital forspecial surgery HSS criteria for knee joint function evaluation, the results were excellent in 9 cases, good in 11 cases,fair 3 cases and poor 2 cases; the excellent and good rate was 80%. Conclusion The double-plating fixation via less-invasivecombinedmedial and lateral approaches has the advantages of better exposure, anatomical reduction, rigid fixationand facilitate functional rehabilitation early. Less-invasive operation reduces soft tissues complications and Conduciveto fracture healing.