本文選題：股骨遠(yuǎn)端骨折 + 內(nèi)外側(cè)雙鋼板　； 參考：《重慶醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的探討臨床上治療股骨遠(yuǎn)端骨折時(shí)雙鋼板的適應(yīng)癥并隨訪其療效與并發(fā)癥。方法2006年3月至2014年4月,我院共手術(shù)治療股骨遠(yuǎn)端骨折60側(cè),根據(jù)固定方法不同分為外側(cè)鎖定鋼板組(單鋼板組)和內(nèi)外側(cè)雙鋼板組(雙鋼板組),其中單鋼板組48側(cè),男23側(cè),女25側(cè),平均年齡為49.0歲；雙鋼板組12側(cè),男6側(cè),女6側(cè),平均年齡46.0歲。術(shù)中完成外側(cè)鎖定鋼板固定后,常規(guī)行膝關(guān)節(jié)內(nèi)外翻應(yīng)力試驗(yàn),在排除外側(cè)副韌帶斷裂后,若內(nèi)翻應(yīng)力試驗(yàn)陽性,則行雙鋼板固定。術(shù)中根據(jù)骨折處缺損情況確定是否植骨。術(shù)后常規(guī)行止痛、預(yù)防傷口感染、預(yù)防深靜脈血栓形成等處理,術(shù)后72小時(shí)內(nèi)開始行患側(cè)膝關(guān)節(jié)主、被動(dòng)屈伸功能鍛煉。術(shù)后隨訪12月-48月,平均隨訪15.9個(gè)月。隨訪內(nèi)容包括：傷口愈合情況、有無骨折復(fù)位丟失、骨折愈合情況、有無內(nèi)固定斷裂,術(shù)后一年行患肢Kolmert膝關(guān)節(jié)功能評價(jià)。結(jié)果 所有患者均獲隨訪,單鋼板組與雙鋼板組各有一例患者于術(shù)后一年半因其它原因死亡�；颊吣挲g分布情況如下：40歲及以下有21側(cè),41-50歲有14側(cè),50歲以上有25側(cè)。單鋼板組平均隨訪時(shí)間為15.2月,平均骨折愈合時(shí)間為14.3月；雙鋼板組平均隨訪時(shí)間為18.5月,平均骨折愈合時(shí)間為18月,兩組的平均骨折愈合時(shí)間無顯著性差異(p=0.559)。雙鋼板組的平均手術(shù)時(shí)間為180分鐘,平均術(shù)中出血量約為814毫升；單鋼板組的平均手術(shù)時(shí)間為145分鐘,平均術(shù)中出血量約為513毫升,兩組術(shù)中出血與手術(shù)時(shí)間均無顯著性差異。雙鋼板組中C型骨折比例(100%)及術(shù)中植骨率(91.7%)均明顯高于單鋼板組。單鋼板組患者中有1例術(shù)后出現(xiàn)內(nèi)固定斷裂,行內(nèi)固定取出+取自體髂骨植骨+外側(cè)解剖鋼板內(nèi)固定術(shù)。術(shù)后骨折愈合,未再出現(xiàn)內(nèi)固定斷裂、松動(dòng)。雙鋼板組中術(shù)后無1例出現(xiàn)內(nèi)固定松動(dòng)、斷裂,亦無骨折復(fù)位丟失、膝關(guān)節(jié)內(nèi)翻畸形。所有患者傷口均愈合。根據(jù)Kolmert評估標(biāo)準(zhǔn)對術(shù)后1年時(shí)膝關(guān)節(jié)的功能進(jìn)行評估,單鋼板組優(yōu)15側(cè),良24側(cè),可7側(cè),差2側(cè),優(yōu)良率為81.25%；雙鋼板組優(yōu)4側(cè),良5側(cè),可2側(cè),差1側(cè),優(yōu)良率為75.0%,兩組優(yōu)良率無顯著性差異(p=0.692)。結(jié)論外側(cè)鎖定鋼板固定為治療股骨遠(yuǎn)端骨折的常用方法,當(dāng)外側(cè)鋼板固定后,若膝關(guān)節(jié)內(nèi)翻應(yīng)力試驗(yàn)陽性,且排除外側(cè)副韌帶斷裂,可加用內(nèi)側(cè)鋼板增加骨折的穩(wěn)定性,避免術(shù)后骨折不愈合和膝關(guān)節(jié)內(nèi)翻畸形。雙鋼板固定在手術(shù)時(shí)間、術(shù)中出血、骨折愈合時(shí)間、膝關(guān)節(jié)功能等方面與單鋼板固定無顯著差異。
[Abstract]:Objective to investigate the indication of double plate in the treatment of distal femur fracture and follow up its curative effect and complication.Methods from March 2006 to April 2014, 60 distal femur fractures were treated in our hospital. According to the fixation methods, 60 sides were divided into two groups: the lateral locking plate group (single plate group) and the internal and external double plate group (double plate group, 48 sides of which were single plate group).The mean age was 49.0 years old in 23 sides of male and 25 sides of female, 12 sides of double plate group, 6 sides of male and 6 sides of female, with an average age of 46.0 years.After the lateral locking plate was fixed during the operation, the internal and external stress test of the knee joint was routinely performed. After the lateral collateral ligament rupture was excluded, if the varus stress test was positive, double plate fixation was performed.The bone graft was determined according to the defect of fracture.The treatment of pain relief, wound infection and deep vein thrombosis were performed. The knee joint was active and passive flexion and extension function exercises were performed within 72 hours after operation.Postoperative follow-up ranged from 12 months to 48 months, with an average follow-up of 15.9 months.The follow-up included wound healing, loss of fracture reduction, fracture healing and internal fixation fracture. The knee joint function of the affected limb was evaluated with Kolmert one year after operation.Results all the patients were followed up. One case of single plate group and one case of double plate group died from other causes one and a half years after operation.The age distribution of the patients was as follows: 21 patients aged 41-50, 14 patients aged 50 or older, 25 patients aged 50 or above.The average follow-up time of the single plate group was 15.2 months, the average fracture healing time was 14.3 months, the average follow-up time of the double plate group was 18.5 months and the average fracture healing time of the two groups was 18 months. There was no significant difference in the average fracture healing time between the two groups.The average operative time of double plate group was 180 minutes, the average intraoperative bleeding was 814 ml, the average operative time of single plate group was 145 minutes and the average intraoperative bleeding was about 513 ml. There was no significant difference between the two groups in intraoperative bleeding and operative time.The ratio of C type fracture and intraoperative bone graft in double plate group was significantly higher than that in single plate group.In one case of single plate group, internal fixation fracture occurred after operation. Internal fixation was performed with external anatomical plate of autogenous iliac bone graft.Fracture healing after operation, no more internal fixation fracture, loosening.In the double plate group, there was no loosening of internal fixation, fracture, loss of fracture reduction and varus deformity of knee joint.All patients were healed.According to the Kolmert evaluation criteria, the knee joint function in the single plate group was excellent in 15 sides, good in 24 sides, fair in 7 sides, poor in 2 sides, the excellent and good rate was 81.25 in the single plate group, excellent in 4 sides, good in 5 sides, fair in 2 sides and poor in 1 side in the double plate group.The excellent and good rate was 75.0. There was no significant difference in the excellent and good rates between the two groups.Conclusion Lateral locking plate fixation is a common method for the treatment of distal femur fracture. If the lateral plate fixation is positive for the varus stress test of the knee joint and the lateral collateral ligament is excluded, the medial plate can be added to increase the stability of the fracture.Avoid nonunion of fracture and varus of knee joint after operation.There was no significant difference between double plate fixation and single plate fixation in operative time, intraoperative bleeding, fracture healing time and knee joint function.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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