Supracondylar and Intercondylar Fractures of the Femur - Results of Surgical

股骨髁上骨折與髁間骨折-手術治療的結果

陳世豪(Shyh-Haru Chen) ； 王俊聞(Jing-Wun Wang)

《Journal of Orthopaedic Surgery Taiwan》 8卷2期 (1991/06) Pp. 63-73

摘要

高雄長庚紀念醫院骨科從民國75年1月至77年12月，三年間共有81例骨髁上與髁閒骨折接受手術治療。除8例曾在院外處理，發生合併症，再來本院進行重建手術外，餘73例階是外傷性骨折。其中股骨髁上骨折與髁間粉碎性骨折有33例(46%)，開放性骨折有23例(32%)，同側下肢受傷有24例(34.4%)對手術處理方式有影響。65例經過平均20.5個月的追蹤檢查，以95-degree condylar plate作內固定術者54例(83%)，結果有76%滿意度；另11例因開放性骨折、關節面嚴重粉碎、軟組織缺損，只能用輔助性鋼釘整復關節面，術後給予骨骼牽引，再以石膏維繫正位，其滿意席只有27%，且2例產生假性關節。霍氏外固定術對於延續性的傷口感染，軟組織欲儘早重建，或不易施行內固定術的困難病例，不失為兼顧處理的好方法。

並列摘要

Seventy-three cases of femoral supracondylar and/or intercondylar fractures treated with surgical method were retrospectively evaluated from January 1986 to December 1988. The A.S.I.F. classification was used to categorize the fracture patterns. The most complex types, C2 and C3, were comminuted fractures of femoral supracondylar and intercondylar area that occupied 46% of all. Twenty-three patients sustained open fractures and 24 patients had associated injuries of the ipsilateral lower limb. Degrees of open fractures and soft tissue damage, fracture patterns and concomitant injuries of ipsilateral lower limb influenced the surgical results. The followup period in 65 cases ranged from 12 to 48 months (average, 20.5 months). Fifty-four fractures (83%) were treated with 95-degree condylar blade plate or buttress plate fixation and obtained 76% excellent or good results. The other 11 fractures could only be supplemented with minimal implants and external immobilization due to severe comminution of intra-articular component or unfavorable open would. Only 27% good result was achieved. Stiffness of knee joint, delayed union, non-union, malunion and infection were the major complications. Hoffmann’s external fixator can provide stabilization of fracture, positional drainage of debris and access for soft tissue reconstruction in contrast to long-term skeletal traction, but its adverse effect on the motion of knee joint must be considered.

並列關鍵字

femoral supracondylar and intercondylar fracture ； 95-degree condylar blade plate