Comparison Of Soft Tissue Damage And Clinical Efficacy Between New Anterolateral Approach And Conventional Approach In Treating Type C Distal Femoral Fractures

Objective: To compare soft tissue damage and rehabilitation of knee jointfunctions between new anterolateral approach and conventional approach in treatingtype C distal femoral fractures.Methods: From January2012to January2014,60patients with type C distalfemoral fractures in our hospital were randomly divided into two groups underwentopen reduction and internal fixation surgical operation who meet its standards.28patients underwent anterolateral approach (along the space between vastus lateralismuscle and rectus femoris, cut along the muscle fiber direction from the far endvastus intermedius to the expansion of the quadriceps, curved downward, cut thelateral patellar retinaculum and articular capsule,along the lateral patellar to the top oftibial tuberosity)and other32patients underwent conventional approach(lateralapproach or anterolateral approach). The study record operation time, blood loss,seroma volume of drainage after surgery, number of intraoperative fluoroscopy,number of complication, length of hospital stay, and drawing venous blood to clinicallaboratory detected creatine kinase and c-reactive protein at preoperative1hour,postoperative6hours, postoperative12hours, postoperative24hours. Two groups ofpatients were followed up, the last follow-up according to the HSS score standardassess rehabilitation of the knee joint functions.Results:(1) The operation was successfully completed in all patients. Theoperation time, blood loss, seroma volume of drainage after surgery, perspectivefrequency during operation in the new anterolateral group were significantly less thanthose in the conventional group, showing significant statistically(P<0.05).Comparison of the complication and length of hospital stay were no significantdifference(P>0.05).(2) The differences of c-reactive protein levels and creatinekinase levels at each postoperative time point compared with preoperative time pointin new anterolateral approach group and conventional approach group weresignificant statistically (P<0.05). The differences of c-reactive protein levels at each time point after surgery between the two groups were not significant statistically(P>0.05). The differences of creatine kinase levels at each time point after surgerybetween the two groups were significant statistically (P<0.05). The trauma of the newanterolateral group were significantly less than the conventional group.(3) Allpatients were followed up1-24months (mean,16months). The differences of theknee HSS score of patients at the last follow-up between the two groups weresignificant statistically (P<0.05). The new anterolateral group were significantlysuperior than the conventional group.Conclusions：New anterolateral approach for type C distal femur fractures is aneffective way, which has advantages of obvious exposure, simple manipulation,anatomical reduction, stable fixation, facilitate patients early post-operative functionalexercise.The damage of soft tissue injury and blood loss and the operation time is less,improve surgical safety. And effectively protect of the iliotibial band and the extensormechanism, reduce scar healing, improve rehabilitation of knee joint functions.