| Objective:Discussing how to choose the best biological osteosynthesis method for curring the fracture of the distal end of femur, through contrasting the effectiveness between locking compression plate and converse interlocking nail using in the therapy of the fracture of the distal end of femur。Method:Retrospectively analyse the difference in length of operation, amount of bleeding and times of pyeloscopy in the operation, and also in expense of the internal fixation, time for union of the fracture, and function of the brethrens between locking compression plate and converse interlocking nail using in the therapy of the fracture of the distal end of femur. All the 33 cases had been treated in the Peoples Liberation Army 208 hospital from 2001 to 2009。divide all the 33 cases into two groups:GSH group and locking compression plate group.18 cases in the anterior group,12 are male and 6 are female. They are 16 to 75 years old,38.9 years averagely.10 of them get the fracture from traffic accident,3 from tumbling injury,2 from injury by falling. AO/OTA grouping:13 are A-types,5are A1-types,4 are A2-types,4 are A3-types.5 are C-types,3 are C1-types,2 are C2-types.4 cases have open fracture.15 cases in the posterior group,11 are male and 4 are female. They are 24 to 72 years old,40.1 averagely. 9 of them get the fracture from traffic accident,4 from tumbling injury,1 from injury by falling. AO/OTA grouping:7 are A types,1 is A1-types,2 are A2-types,3 are A3-types.8 are C-types,2 are C1-types,3 are C2-types,3 are C3-types.4 cases have open fracture. The results are dealed with SPSS13.0, Contrasted with student t test, and divergence has statistical significance when P<0.05.Results:All the 33 cases were given follow-up visits from 6 to 28 monthes, 19 monthes averagely. As the presentation of Results showed in the tables:in the GSH groups:length of operation is 55-125min,116.6min averagely; amount of bleeding is 180-450ml,256ml averagely; times of pyeloscopy are 8-16 times, 13.8 times; expense of the internal fixation is 3.00-7.28 thousands,4.9 thousands averagely; time for union of the fracture are12-32 weeks,10 weeks averagely; Grade of Kolment of the 18 cases:10 are excellent,4 are good,3 are moderate, 1 is bad, the Kolmert is 78%, none of the 10 cases has infection, delayed union of fracture, or deep venous thrombosis or nonunion of fracture. In the converse interlocking nail group:length of operation is 70-110min, 100min averagely; amount of bleeding is 190-400ml,192.6ml averagely; times of pyeloscopy arc 10-18 times,15.6 times averagely; expense of the internal fixation is 14.28-21.4 thousands,17.21 thousands averagely; time for union of the fracture are 12-34 weeks,15.5 weeks averagely. Grade of Kolment of 15 cases:9 are excellent,3 are good,1 is moderate,2 are bad, the Kolmert is 80%, none has infection, delayed union of fracture, or deep venous thrombosis or nonunion of fractureConclusions:According to these factors including AO classification, degree of the soft tissue trauma, reception of the patient, we decide to choose locking compression plate or converse interlocking nail.1. Converse interlocking nail is better than locking compression plate in curring simple A-type, and it provides motorization when bone Delayed healing is happen,which advances union of the fracture. However, there is no obvious difference in curring comminuted fracture.2. To the C3-type fracture with a badly friableness, which is difficult for the reduction of the articular surface,we'd better choose the locking compression plate, because it is more stable in angulation. |
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