外固定架治疗危重患者股骨远端骨折的疗效分析

张红新; 张羽; 古雪建; 丁思广; 杨朔; 胡长青; 白晓亮; 连勇

doi:10.3969/j.issn.2095-5227.2021.03.014

外固定架治疗危重患者股骨远端骨折的疗效分析

External fixator in treatment of distal femoral fracture in critically ill patients

摘要

摘要:
背景股骨远端骨折合并其他危重症患者往往无法耐受骨折切开复位内固定手术，如行保守治疗，关节面无法复位，会遗留明显后遗症。外固定架具有手术创伤小、手术时间短、固定可靠的特点，但其治疗股骨远端关节内骨折临床疗效尚无定论。
目的探讨应用外固定架治疗危重患者股骨远端骨折的临床疗效。
方法分析2015年8月- 2019年10月我科收治的合并其他部位损伤的股骨远端骨折患者18例，所有患者均应用外固定架手术治疗，术后指导患者膝关节康复锻炼。所有患者均获得随访，终末随访时采用美国特种外科医院(Hospital for Special Surgery，HSS)评分评估膝关节功能。
结果男性患者16例，女性2例。年龄21～75岁，平均42岁。受伤原因：坠落伤7例，交通事故伤9例，重物砸伤2例。采用国际内固定研究会/美国骨科创伤学会分类法，B型骨折2例，C型骨折16例。受伤至手术时间8～18 d，平均14 d。18例骨折患者经术后9～18个月随访，平均随访14个月，骨折均获愈合，愈合时间3～10个月，平均5.2个月。HSS评分：优3例，良11例，可3例，差1例，优良率77.8%。
结论外固定架治疗股骨髁间骨折具有创伤小、固定可靠、术后功能恢复好的优点，是治疗合并其他部位损伤的股骨远端骨折的可选方法。

Abstract:
Backgroud Distal femoral fractures combined with other critically ill patients often cannot tolerate open reduction and internal fixation of the fracture. If conservative treatment is performed, the articular surface cannot be reset, which will leave obvious sequelae. The external fixator has the characteristics of small surgical trauma, short operation time, and reliable fixation, but its clinical efficacy in the treatment of intra-articular fractures of the distal femur is still inconclusive.
Objective To investigate the clinical effect of external fixation on the treatment of distal femoral fractures in critically ill patients.
Methods A total of 18 patients with distal femoral fractures with other injuries were treated in our department from August 2015 to October 2019. All patients were treated with external fixator surgery. After operation, the patients were instructed to recover and exercise the knee joint, and all patients were followed up. The Hospital for Special Surgery (HSS) score was used to rank the function of knee joint at the last follow-up.
Results There were 16 males and 2 females with average age of 42 years (range: 21 - 75 years). The causes of fracture included falling (7 cases), traffic accident injury (9 cases), and injured by heavy objects dropping (2 cases). The AO/ASIF classification was used, with 2 cases of B-type fractures and 16 cases of C-type fractures. The time from injury to operation was 8-18 days, with an average of 14 days. Eighteen patients with fractures were followed up from 9 months to 18 months after surgery, with an average follow-up of 14 months. All fractures were healed. The healing time ranged from 3 months to 10 months, with an average of 5.2 months. According to the American Hospital for Special Surgery (HSS) scoring, 3 cases achieved excellent result, 11 cases were good, 3 cases were fair, and 1 case was poor. The excellent and good rate was 77.8%.
Conclusion External fixation for femoral intercondylar fractures is less invasive, with firm fixation and good postoperative function recovery, which is an ideal method for treating femoral intercondylar fractures with other parts of injury.

HTML全文

参考文献(24)

施引文献

资源附件(0)