Treatment on femoral shaft and distal femoral fractures with intramedullary nail and locking plate: reliable internal fixation

doi:10.3969/j.issn.2095-4344.2014.40.018

Abstract

Abstract:

BACKGROUND: There are many reports about clinical effect of femoral fractures with intramedullary nail and distal femoral fractures with locking plate. However, there is less report about clinical effect of femoral and distal femoral fractures.

OBJECTIVE: To investigate the clinical effect of femoral and distal femoral fractures using intramedullary nail combined with locking plate.

METHODS: Eighteen patients with femoral and distal femoral fractures were treated by internal fixation with intramedullary nail combined with locking plate. Among them, six cases had femoral and supracondylar fractures, seven cases had femoral and condylar fractures, and five cases had femoral and intercondylar fractures. According to the AO classification, three cases were type 33A2, three cases were type 33A3, two cases were type 33B1, five cases were type 33B2, one case was type 33C1, three cases were type 33C2, and one case was type 33C3. The fractures union and complications were followed up and observed, and knee joint function was judged by HSS score.

RESULTS AND CONCLUSION: All the 18 patients were followed up for 12-24 months. The time for fracture union ranged from 3 to 5 months, average 3.4 months. No infection and disunion, no fracture malunion, no internal fixation loosening and breaking, no refracture happened. The HSS score ranged from 68 to 96 points, average 86.8 points. There were 12 excellent cases, 5 good cases, and 1 common case. The excellent and good rate was 94.4%. The internal fixation using intramedullary nail combined with locking plate is a good method for treatment of femoral and distal femoral fractures, due to less surgical trauma, simple and reliable fixation, high rate of fracture healing, low rate of complications, and excellent function.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: internal fixators, femoral fracture, fracture healing, surgery, microinvasive

CLC Number:

R318

Han Jun-zhu, Zhu Xun-bing, Zhang Tao, Chen Hui . Treatment on femoral shaft and distal femoral fractures with intramedullary nail and locking plate: reliable internal fixation[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(40): 6501-6506.

Figures/Tables 1

2.1 参与者数量分析按意向性处理，纳入患者18例，均获随访，随访时间12-24个月，全部进入结果分析。 2.2 骨折愈合情况本组病例处理股骨干骨折采用闭合复位髓内钉固定，处理股骨远端骨折采用有限切开复位锁定板固定，治疗前行骨牵引帮助骨折初步复位，术中应用牵引床及C臂机，使骨折在尽可能满意复位固定的同时，减少复位固定过程中对骨折血供的再次破坏，故本组18例于治疗后3-5个月骨折愈合，平均3.4个月愈合。 2.3 并发症发生情况因治疗前采用的恰当处理措施，术中减少了不必要的创伤，且治疗后功能锻炼适时适度，故本组病例术中无重要血管、神经损伤，治疗后无感染、切口不愈合、骨折畸形愈合、内固定松动断裂、再骨折发生。1例33C3型骨折患者伴有同侧胫骨平台骨折，因骨折及软组织损伤严重、术后镇痛处理后锻炼时仍有疼痛，愈合发生膝关节软组织粘连、僵硬、屈曲功能受限、跛行，准备于取出内固定时进行软组织松解，余17例愈后膝关节功能良好。 2.4 膝关节HSS评分治疗后12个月膝关节HSS评分为68-96分，平均86.8分；优(85-100分)12例，良(70-84分)5例，中(60-69分)1例，优良率为94%。 2.5 典型病例男性患者，42岁。车祸致右大腿疼痛、畸形、活动障碍2 h入院。入院查体：右下肢外旋肿胀畸形，皮肤完整，右股骨中段及内髁压痛(++)，右足背及胫后动脉搏动有力，右足屈伸可，无其他合并伤。X射线片示：右股骨干中段骨折合并右股骨内髁矢状面骨折(图1A，B，C)。诊断为右股骨干骨折合并右股骨远端骨折(33B2型)。入院后行胫骨结节骨牵引，10 d后行右股骨干合并股骨远端骨折髓内钉结合锁定板内固定治疗。治疗后3个月骨折愈合，无并发症发生。获随访18个月，右膝无疼痛，伸曲活动正常，治疗后12个月HSS评分为94分。治疗后即刻X射线片见图1D，治疗后18个月X射线片见图1E，F。"

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