目的比较股骨逆行髓内钉附加外侧锁定钢板与股骨内外侧双钢板治疗AO/OTA 33C型股骨远端骨折的临床疗效。方法回顾分析2017年6月至2022年12月在我院接受治疗的78例AO/OTA 33C型股骨远端骨折患者,其中股骨逆行髓内钉附加外侧锁定钢板治疗患者42例(钉板组),股骨内外侧双钢板治疗患者36例(双钢板组)。记录两组患者的手术时间、术中出血量、下床负重时间,骨折愈合时间、视觉模拟评分(visual analogue scale,VAS)、膝关节活动度(range of motion,ROM)、美国特种外科(Hospital for Special Surgery,HSS)评分和并发症等指标。结果两组手术时间、术中出血量、负重时间、骨折愈合时间比较差异无统计学意义(P>0.05);术后3个月和6个月,两组VAS评分、膝关节ROM、HSS评分比较差异均无统计学意义(P>0.05)。钉板组术后并发症5例:膝关节僵硬2例、肢体短缩1例、伤口感染2例。双钢板组术后并发症6例:膝关节僵硬1例、延迟愈合2例,伤口感染3例,并发症发生率两组差异无统计学意义(P>0.05)。结论联合固定已成为治疗AO/OTA 33C型股骨远端骨折的趋势,而股骨逆行髓内钉附加外侧锁定钢板和股骨内外侧双钢板固定均是治疗该类型骨折有效的方案,具有固定可靠、有利于快速康复、临床疗效好等优点。
目的:阐述与股骨逆行髓内钉相关的股骨解剖学参数的研究进展。方法:广泛查阅近年国内外相关文献并结合基础研究及临床相关经验,总结分析与股骨逆行髓内钉密切相关的几个重要解剖参数的临床意义及相关测量结果和测量手段等。结果:目前临床常用的髓内钉大多数仍为参照国外人体解剖参数而设计的,而国人股骨解剖参数与西方人种确实存在差异。同时发现股骨长度、股骨标准冠失状面的确定及股骨曲度的相关研究等对股骨逆行髓内针的设计有着决定性的影响。结论:在股骨远端骨折的治疗中,股骨逆行髓内钉有着不可替代的作用,有必要设计一款新型股骨逆行髓内钉使其更符合国人特点。Objective: This study aims to review the advancements in research concerning femoral anatomical parameters pertinent to retrograde intramedullary nails. Methods: Through a comprehensive examination of recent literature both domestically and internationally, alongside foundational research and clinical experience, we summarized and analyzed the clinical significance of several key anatomical parameters closely associated with femoral retrograde intramedullary nails, as well as relevant measurement outcomes and methodologies. Results: Currently, the most commonly utilized intramedullary nails in clinical practice are still designed based on foreign human anatomical parameters;however, it is evident that the anatomical characteristics of the Chinese femur differ significantly from those of Western populations. Furthermore, findings indicate that factors such as femoral length, standard coronary deformity assessment of the femur, and investigations into femoral curvature exert a critical influence on the design of retrograde intramedullary nails for the femur. Conclusion: Retrograde intramedullary nail fixation plays an indispensable role in managing distal femoral fractures. Therefore, there is a pressing need to develop new designs for retrograd
