动力髁螺钉与逆行髓内钉治疗老年股骨髁上骨折：两种方法的比较研究

Supracondylar femoral fractures in elderly patients treated with the dynamic condylar screw and the retrograde intramedullary nail: a comparative study of the two methods.

作者信息

Christodoulou A, Terzidis I, Ploumis A, Metsovitis S, Koukoulidis A, Toptsis C

机构信息

Department of Orthopaedic Surgery, Hippokratio General Hospital, Thessaloniki, Greece.

出版信息

Arch Orthop Trauma Surg. 2005 Mar;125(2):73-9. doi: 10.1007/s00402-004-0771-5. Epub 2004 Dec 21.

DOI:10.1007/s00402-004-0771-5

PMID:15611863

Abstract

INTRODUCTION

The objective of this study is to present the results of surgical management of supracondylar fractures of the femur (types A and C according to the AO/ASIF classification) in elderly patients with the use of two different methods of fixation: the mini open dynamic condylar screw fixation (DCS) and the closed retrograde intramedullary nailing (RIN).

MATERIALS AND METHODS

Eighty patients with supracondylar fractures of the femur were treated from January 1994 to June 2000 and 72 of them followed up completely. There were 25 (34%) men and 47 (65%) women with a median age of 73.2 years (range 60-88 years). In patients with the same type of fracture, the chosen method was random, one after the other (alternately). RIN was used in 35 patients, and DCS was used in 37. The mean operative time for the DCS fixation group was 145 min (range 115-180 min), whereas for the RIN group it was 92 min (range 76-110 min) (p<0.001) with an average estimated blood loss of 310 cc (range 120-450 cc) and 118 cc (range 90-165 cc), respectively (p<0.001). The mean follow-up was 28 months (range 18-42 months).

RESULTS

According to the criteria set by Schatzker and Lambert, excellent results were recorded in 18 (51%), good in 11 (31%), moderate in 3 (9%), poor in 3 (9%) patients with RIN and excellent in 19 (51%), good in 11 (30%), moderate in 4 (11%) and poor in 3 (8%) patients with DCS (p>0.05). The complications that occurred in the RIN group were 2 (6%) stiffness of the knee (mean flexion 80 degrees), 2 (6%) non-unions, 2 (6%) varus deformity and in the DCS group 2 (5%) haematomas, 4 (11%) stiffness of the knee (mean flexion 73 degrees) and 2 (5%) non-unions.

CONCLUSION

Although the two methods appear to have the same percentage of excellent results and same time to bony union, RIN is preferable to DCS in terms of less blood loss and shorter operating time.

摘要

引言

本研究的目的是介绍采用两种不同固定方法治疗老年患者股骨髁上骨折（根据AO/ASIF分类为A型和C型）的手术治疗结果：微型开放动力髁螺钉固定（DCS）和闭合逆行髓内钉固定（RIN）。

材料与方法

1994年1月至2000年6月期间，对80例股骨髁上骨折患者进行了治疗，其中72例得到了完整随访。男性25例（34%），女性47例（65%），中位年龄73.2岁（范围60 - 88岁）。对于同一类型骨折的患者，所选方法是随机交替进行的。35例患者采用RIN，37例患者采用DCS。DCS固定组的平均手术时间为145分钟（范围115 - 180分钟），而RIN组为92分钟（范围76 - 110分钟）（p<0.001），平均估计失血量分别为310毫升（范围120 - 450毫升）和118毫升（范围90 - 165毫升）（p<0.001）。平均随访时间为28个月（范围18 - 42个月）。

结果

根据Schatzker和Lambert制定的标准，RIN组中18例（51%）结果为优，11例（31%）为良，3例（9%）为中，3例（9%）为差；DCS组中19例（51%）结果为优，11例（30%）为良，4例（11%）为中，3例（8%）为差（p>0.05）。RIN组发生的并发症为2例（6%）膝关节僵硬（平均屈曲80度），2例（6%）骨不连，2例（6%）内翻畸形；DCS组发生的并发症为2例（5%）血肿，4例（11%）膝关节僵硬（平均屈曲73度），2例（5%）骨不连。