CAJ | 학술논문

背景：目前，内固定植入物治疗股骨远端骨折的方式有多种，较多使用的方法为锁定加压钢板、顺行髓内钉和逆行髓内钉，临床对这3种固定方法的疗效持不同观点。 　　目的：通过对股骨远端骨折锁定加压钢板、顺行髓内钉和逆行髓内钉治疗方法的比较，选择合适的内固定方法。 　　方法：回顾性分析118例股骨远端骨折行内固定治疗患者临床资料，分别采用锁定加压钢板38例，顺行髓内钉21例，逆行髓内钉59例，比较3组内固定植入过程中失血量、手术时间、骨折愈合时间、以及膝关节术后恢复的优良率。 　　结果与结论：118例患者均获随访，时间为14-26个月，平均为20个月。所有患者未发生感染，1例患者因骨病例骨折导致骨缺失愈合延迟，采用骨填充后在第19周基本完全愈合，其余均在4.5个月内愈合。在骨折愈合时间上3者比较，差异无显著性意义(P>0.05)。术中失血量及手术时间方面，顺行髓内钉组和逆行髓内钉组均优于锁定加压钢板组，顺行髓内钉组要优于逆行髓内钉组，差异有显著性意义(P<0.05)。锁定加压钢板组、顺行髓内钉组及逆行髓内钉组3者膝关节Kolment的评分优良率分别为76.3%，52.4%，86.4%。说明逆行髓内钉内固定牢固，稳定可靠，出血量少，创伤小、骨折易复位等优点，特别在膝关节功能恢复方面表现效果更好，与锁定加压钢板及顺行髓内钉组比较，逆行髓内钉治疗股骨远端骨折更有优势。
배경：목전，내고정식입물치료고골원단골절적방식유다충，교다사용적방법위쇄정가압강판、순행수내정화역행수내정，림상대저3충고정방법적료효지불동관점。 　　목적：통과대고골원단골절쇄정가압강판、순행수내정화역행수내정치료방법적비교，선택합괄적내고정방법。 　　방법：회고성분석118례고골원단골절행내고정치료환자림상자료，분별채용쇄정가압강판38례，순행수내정21례，역행수내정59례，비교3조내고정식입과정중실혈량、수술시간、골절유합시간、이급슬관절술후회복적우량솔。 　　결과여결론：118례환자균획수방，시간위14-26개월，평균위20개월。소유환자미발생감염，1례환자인골병례골절도치골결실유합연지，채용골전충후재제19주기본완전유합，기여균재4.5개월내유합。재골절유합시간상3자비교，차이무현저성의의(P>0.05)。술중실혈량급수술시간방면，순행수내정조화역행수내정조균우우쇄정가압강판조，순행수내정조요우우역행수내정조，차이유현저성의의(P<0.05)。쇄정가압강판조、순행수내정조급역행수내정조3자슬관절Kolment적평분우량솔분별위76.3%，52.4%，86.4%。설명역행수내정내고정뢰고，은정가고，출혈량소，창상소、골절역복위등우점，특별재슬관절공능회복방면표현효과경호，여쇄정가압강판급순행수내정조비교，역행수내정치료고골원단골절경유우세。
BACKGROUND:There are various internal fixators in treatment of distal femoral fracture. The commonly used fixators are locking compression plate, anterograde intramedul ary nails and retrograde intramedul ary nails. However, the efficacy of three common fixation is controversial. OBJECTIVE:To compare the effect of locking compression plate, anterograde intramedul ary nails and retrograde intramedul ary nails for treatment of distal femoral fracture, and to select the appropriate internal fixation method. METHODS:From May 2007 to November 2007, 118 patients with distal femoral fractures were treated with internal fixation in the hospital and their clinical data were analyzed retrospectively. Among them, 38 cases received locking compression plate, 21 cases received anterograde intramedul ary nails, and 59 cases received retrograde intramedul ary nails. The intraoperative blood loss, operative time, fracture healing time and rate of good postoperative recovery of knee joint in three groups were compared. RESULTS AND CONCLUSION:Al the involved 118 patients were fol owed up for 14-26 months, average 20 months. No patients developed infection. Except one case delayed bone defect healing due to the fractures and was completely healed after bone fil ing at 19 weeks, the other cases healed within 4.5 months. There was no significant difference in fracture healing time among three groups (P>0.05). Intraoperative blood loss and operation time in anterograde intramedul ary nail group and retrograde intramedul ary nail group were superior to locking compression plate group. In addition, anterograde intramedul ary nail group was superior to retrograde intramedul ary nail group, with significant difference (P<0.05). Kolment grading fine rate in locking compression plate, anterograde intramedul ary nail and retrograde intramedul ary nail groups was 76.3%, 52.4%and 76.3%respectively. Retrograde intramedul ary nail fixation is firm, stable and reliable, with less intraoperative blood loss, shorter operation time, smal trauma, and easy fracture reset, especial y in the recovery of knee joint function. Compared with locking compression plate and anterograde intramedul ary nail, retrograde intramedul ary nailing treatment of distal femoral fractures has more advantages.