| Objective To compare clinical effect of microendoscopic-assited retrograde interlocking nailing (MPRIN) for fracture of distal femur with those of conventional open retrograde interlocking nailing (ORIN), and to determine whether MPRIN would be sufficient for fracture of distal femur.Methods From Feb.2008 to Dec.2008, All the patients who met the inclusion criteria and exclusion criteria were divided into two group according to table of random number. The patients who were odd numbers were treated with the MPRIN and those who were even number were treated with the ORIN. Knee joint continuous passive motion and musculus quadriceps fexoris initiative contraction exercises were allowed by the patients postoperatively.The evaluation was carried out in the postoperative period, and surgical time, blood loss, hospital stay, time of bone union, Lysholm Scores and Knee function assessment standards results by Kolment were recorded. Using SPSS 16.0 statistic software to deal with all the data and make 0.05 the boundary of statistical significance.Measurement datas were compared with two independent sample t test and Mann-Whitney U test, Count datas were compared with theχ2 test and Mann-Whitney U test.Results There were 62 pations included in this study. Group MPRIN had 32 pations and group had 30 pations. There were no significant difference of the average age, sex, fracture type, injury cause, time from injury to surgery or the type of trauma between the two groups (all p values>0.05). All patients were followed up retrospectively for at least 12 months (mean,13.4 months; range,12-15months) to compare the clinical results between the MPRIN and the ORIN.Group MPRIN:The average operative time was 96.59±14.28 minutes, and the average blood loss was 125.31±27.71ml, the average hospital stay was 11.47±1.83 days. All the fractures were united on an average of 103.34±25.35 days postoperatively except three pations who were delayed union and two pations who were malunion. Function of the knee was assessed by Kolment evaluation standards, excellent and good rate of the MPRIN was 78.13% at 1 months postoperatively,87.5% at 3months postoperatively,90.63% at 12 months postoperatively. According to Lysholm rating scales, the MPRIN was 77.09±14.15 at 3 months postoperatively,95.53±3.37 at 12 months postoperatively.Group ORIN:The average operative time was 115.50±18.02 minutes, and the average blood loss was 179.98±30.83ml, the average hospital stay was 15.83±2.05 days. All the fractures were united on an average of 102.03±23.04 days postoperatively except two pations who were delayed union, two pations who were malunion, three pations had nail tail Impingement,four pations had effusion of joint.No injuries of nerves and vessels, infection,no breakage or loosing of internal fixation instruments occurred in the two group. Function of the knee was assessed by Kolment evaluation standards, excellent and good rate of the MPRIN was 53.3% at 1 months postoperatively,63.3% at 3months postoperatively, 70% at 12 months postoperatively. According to Lysholm rating scales, the MPRIN was66.37±12.84 at 3 months postoperatively,86.43±4.72 at 12 months postoperatively.There were no significant difference of time of bone union between the two groups (all p values>0.05). There were ignificant difference of surgical time, blood loss, hospital stay, time of bone union, Lysholm Scores and Knee function assessment standards results between the two groups(all p values<0.05).Conclusion Fracture of distal femur treated with microendoscopic-assited percutaneous retrograde interlocking nailing is proved to have many advantages,such as less trauma and blood loss, accurate inserting the nailing, and less complications, are beneficial to functional revovery of the knee. |
