摘要目的 探讨合并髁部骨折的股骨干复杂骨折(A0 C2、C3型)的外固定支架手术治疗方法及后续治疗的临床效果评价.方法 对2001年1月-2007年1月通过手术治疗的累及股骨髁骨折的42例股骨干粉碎性骨折患者的治疗结果进行分析.按AO/ASIF原则分类,股骨干中远端骨折分别为C2型(多段骨折)18例,C3型(不规则)骨折24例.手术采用简单内固定加外固定架固定C3型,单纯外固定架固定C2型;4例采用续贯固定.结果 42例患者全部获随访,按Kotmert股骨远端骨折功能评价标准,膝关节功能满意35例(83%),可6例(14%),不满意1例(2%).结论 通过外固定支架的方法治疗合并髁部骨折的股骨干复杂骨折(A0 C2、C3型)可最大限度地恢复股骨的相对长度,且便于在术后对股骨关节面与股骨干纵轴进行水平和纵向调整,使其与对侧股骨中下段达到解剖平行对称关系;术后配合合理的康复锻炼,能使膝关节功能得到最大的恢复.股骨管状结构重建在此类骨折的治疗中应受到重视.

abstractsObjective To discuss external fixation method for the complex diaphyses fracture involving condyles of femur and evaluate its clinical efficacy.Methods A retrospective study was done on 42 patietns with comminuted femur diaphyses fracture combined with distal intra-articular fractures treated surgically from January 2001 to Janurary 2007.There were 24 males and 18 females at mean age of 33 years (20-66 years).According to AO/ASIF classification,there were 18 patients with type C2 fractures and 24 with type C3 ones.Simple internal fixation plus external fixation was performed on patitents with C3 fractures but only external fixation on those with C2 fractures.Four patients were treated with intramedular fixation.Results All patients were followed up for 1-12 months.According to Kotmert's assessment standard on function of proximal femur,the knee function was satisfactory in 35 patients (83% ) ,good in six (14% ) and unsatisfactory in one (2% ).Conclusions Minimally invasive external fixation can utmostly restore relative length of the femur and regulate between articular face of the femur and longitudinal axis of femur shaft to reach a symmetrical relation with middle and inferior part of opposite femur.Postoperative exercise is important for maximal recovery of the knee function.Attention should be paid to reconstruction of tubiform structure of the femur.