逆行髓内钉和钢板置入内固定治疗股骨远端骨折的比较

背景：以髓内钉为基础的中心型固定方法更符合股骨的生物力学特点。 目的：比较股骨远端骨折采用股骨髁上逆行交锁髓内钉治疗与股骨远端解剖型钢板治疗的临床疗效。 方法：用逆行髓内钉治疗35例股骨下端骨折患者和31例钢板内固定患者。内固定后随访1年以上,采用Neer膝关节功能评分标准对膝关节功能恢复程度指标,骨愈合速度指标予以评价。 结果：随访1年患者Neer 膝关节功能评分标准,逆行髓内钉优24例(69%),良9例(26%),可2例(6%),优良率为94%。平均愈合时间4.8个月。股骨远端解剖钢板优21例(68%),良5例(16%),可3例(10%),差2例(6%),优良率为84%,平均愈合时间6.5个月。根据结果进行分析,逆行交锁髓内钉治疗有利于早期下床活动,股骨远端钢板适应证广,对关节面的破坏相对较轻,有利于膝关节功能恢复。2种内固定都能起到较好疗效,应根据股骨远端骨折类型,选择相适应的内固定物。

Comparison of retrograde intramedullary nail and plate implantation for internal fixation for the treatment of distal femur fractures

BACKGROUND:Center fixation method based on the intramedullary nail is more consistent with the bio-mechanical characteristics of the femur. OBJECTIVE:To compare the clinical effects of femoral condyle retrograde intramedullary nail and anatomical distal femur plate fixation for the treatment of distal femoral fractures. METHODS:Thirty-five patients with distal femur fractures were treated with retrograde intramedullary nail fixation and 31 patients were treated with plate fixation, all the patients were followed-up for more than 1 year, and then the recovery of motion of knee joints and the time of bone healing were evaluated by Neer knee society function score criteria. RESULTS AND CONCLUSION:All the patients were followed-up for 1 year. According to Neer knee society function score criteria, in the retrograde intramedullary nail group, 24 cases were excellent (69%), good in 9 cases (26%) and fair in 2 cases (6%); the excellent and good rate was 94%. The average bone healing time was 4.8 months. In the anatomical distal femur plate group, excellent in 21 cases (68%), good in 5 cases (16%), fair in 3 cases (10%), poor in 2 cases (6%), and the excellent and good rate was 84%, the average bone healing time was 6.5 months. The results show that retrograde interlocking intramedullary nail fixation is helpful for early ambulation, while the distal femur plate, with wide indication has relatively light damage to the articular surface and is conducive to the recovery of knee function. All the two internal fixation methods have good medical effects; we should select the compatible fixation according to the classification of distal femoral fractures.