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股骨髁上併髁間骨折－內固定治療結果
Supracondular-Intercondylar Fractures of the Femur Results of Internal Fixation
摘要
三軍總醫院自73年7月至79年6月，共有76例骨髁上併髁間骨折病例。除其中15例接受保守治療、三例因膝膕動脈斷裂接受膝上截肢（截肢率3.9％）外，其餘58例接受手術復位及內固定治療。手術復位的適應症包括1.股骨髁關節面移位性骨折。2.手術後有助於早日恢復正常活動之多處受傷患者。3.手術後足以讓患者儘快恢復膝關節運動或接受復健治療者。4.同側脛骨骨折或膝關節周圍重要苷帶受損患者。術後鼓勵患者儘早活動膝關節。術後石膏固定僅用於曾接受苷帶修補或髕骨切除之患者。有12例於術後失去聯繫，其餘46例接受我們分析其治療結果。骨折依ASIF分類法，分為C1：單純之“Y”型髁上併髁間骨折，有12例；C2類為髁上部位含有骨碎片的“Y”型髁上及髁間骨折，有25例；C3：合併有股骨髁關節面骨折的“Y”型髁上及髁間骨折，有9例。治療結果依NEER的評估方法為準。手術復位後至骨瘉合時間平均14.7週。治療後平均追蹤期23.4個月。膝關節活動範圍其平均值為118度，其值從C1類的123度至C3類的104度。治療結果滿意度C1類91.7％；C2類80.8％；C3類55.6％。平均78.3％。C3類中6例（66.7％）為開放性骨折，且多處受傷患者，因此治療結果較差。
並列摘要
From July 1984 to June 1990, there were 76 cases of supracondylar-intercondylar fractures of the femur at TSGH. Fifteen cases received conservative treatment. Three cases received A-K amputation due to the rupture of popliteal artery. The residual 46 cases were studied in this report. The fractures were classified by ASIF system, with C1 being a simple Y pattern, 12 cases, C2 having additional supracondylar comminution, 25 cases, and C3 having intra-condylar comminution, 9 cases. Postoperatively, early active motion of the knee was encouraged, and brace was used only to protect the repair of associated disruptions of ligaments or fracture of patella. The final results were rated using the system that was described by Neer et al., for fractures of the distal end of the femur. The average time between the operation and fracture healing was 14.7 weeks. The average length of follow-up was 23.4 months. The final average motion of the knee was 118 degrees, ranging 123 degrees (C1 fractures) to 104 degrees (C3 fractures). The average ratio of satisfactory result was 78.3%. The C3 fractures had poor results because 6 cases (66.7%) were open fractures and multiple injuries. Therefore, for patients with supracondylar-intercondylar fractures of the femur, early rigid internal fixation permitted early functional rehabilitation and gained a satisfactory result.
延伸閱讀
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