| Objective:To investigate the relationship between the degree of comminuted fracture of femoral supracondylar fracture and its clinical efficacy.Methods:Using retrospectively analysis,46 cases of supracondylar fractures of the femur from October 2010 to November 2017 were analyzed in the First Affiliated Hospital of Fujian Medical University,including 28 males and 18females,aged from 6 to 89 years old,with an average age of（47.74+22.77）years old.All of patients were fresh supracondylar fractures of the femur,of which 9were open,5 were multiple fractures and 3 were periprosthetic fractures.The clinical data of age,sex,and cause of injury were recorded,and Muller typing[1]法法法的现法;因其多为粉碎性、不不定骨折,respectively,of which 4 cases cases of A3 type,2 cases of C1 type,10 cases of C2 type,12 cases of C3 type（all patients with supracondylar fracture were comminuted fractures）.According to the degree of comminution of the supracondylar fracture,all the patients were divided into non comminuted group（including the A1,A2,C1in the above classification）and the comminuted group（including the A3,C2 and C3 in the above classification）.All the patients were treated with open reduction and internal fixation.Among them,1 cases were treated by retrograde intramedullary nailing,and the other 45 cases were treated with plate internal fixation.Intraoperative time and intraoperative bleeding loss were recorded.Anteroposterior and lateral femoral radiograph was taken routine to evaluate reduction of fracture in Preoperative and postoperative.Special clinic reexamination and telephone follow-up were evaluated according to the HSS knee joint function score standard,and the corresponding results were analyzed with SPSS22.0 statistical software.When P<0.05,there was statistical significance.To observe the relationship between comminution of supracondylar fracture of femoral bone and postoperative curative effect.Results:46 cases were followed up.The average follow-up time was 35.24+23.09 months（3 months to 88 months）.The average follow-up time of the non comminuted group was 25.83+17.55 months（3 months to 63 months）.The average follow-up time of the comminuted group was 38.56+24.10 months（3months to 88 months）.The fractures of 46 patients were all clinically healed in the last follow-up time,and no bones were absent.During the follow-up time,4 cases of wound healing were found,of which 3 cases of surgical incision infection（1cases were open fracture,skin laceration with infection）,1 cases of fat liquefaction,after active dressing treatment and the use of sensitive antibiotics,the incision healed well.The rest of the patients had good healed incision and relatively satisfactory recovery of limb function.Two groups of patients with postoperative soft tissue complications（non comminuted group 8.33%VS comminuted group8.82%,P=1.00>0.05）,intraoperative time（non comminuted group 143.92+51.80minutes VS comminuted group 163.35+55.22 minutes,P=0.099>0.05）,intraoperative bleeding loss(non comminuted group 395.83+342.76 ml VS comminuted group 401.47+277.29 ml,P=0.578>0.05 The score of function（non comminuted group 84.33+6.05 VS,comminuted group 80.88+7.13,P=0.117>0.05）,the differences between two groups was not statistically significant.The average healing time of the two groups（non comminuted group 14.75+1.77weeks VS comminuted group 17.62+2.49 weeks,P=0.000<0.05）,hospitalization days（non comminuted group 20.74+7.21 days VS comminuted group 15.92+8.74 days,P=0.028<0.05）.the differences between the two groups was statistically significant.Conclusion:Open reduction and internal fixation is an ideal method for the treatment of supracondylar fracture of femur and supracondylar fracture on the merger between condylar fracture.Most patients can achieve the desired functional effect by early postoperative knee function training.However,there are no clear guidelines for the timing and method of postoperative knee joint functional training for some patients,especially those with more open fractures and more severe fractures,which need further discussion. |
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