股骨髁部骨折合并中重度顱腦損傷患者手術時機的制定

【摘 要】 目的 研究股骨髁骨折合并中重度顱腦損傷患者手術時機的制定。方法 自2007年6月-2012年3月，我院對47例患者股骨髁骨折進行了手術治療。手術方法為外固定架（2例），倒打釘（3例），動力髁鋼板（16例），股骨髁解剖鋼板19例，拉力螺釘或空心釘固定（7例）。按照入院時GCS評分分三組，第一組，9-10分，17例；第二組，6-8分，20例；第三組，5分以下，10例。統計各組平均等待手術時間。按照手術時GCS評分分二組，第一組，9分以上，37例；第二組，5-8分，10例。統計各組平均等待手術時間。按照平均等待手術時間分三組，小于14天手術患者，15-28天之間手術患者，超過28天手術患者，對各組平均實施手術時間及術后切口引流量進行統計。隨訪8個月，每個月患肢拍x光片，記錄手術后第三個月膝關節功能，每個組之間在進行相關性分析統計。結果 入院時GCS評分分組，三組平均等待手術時間分別為13.4天、24.9天、36.6天。手術時GCS評分分組，兩組平均等待手術時間分別為19.6天、36.6天。按照平均等待手術時間分組，三組平均實施手術時間分別為88.8m、112.6m、152.4m；三組術后切口的平均引流量分別為237.6ml、570.8ml、825.3ml。膝關節功能：優12例，良21，可6，差12例。再根據每個組相關性分析得GCS評分與等待手術時間天密切相關，相關系數為0.92。結論 顱腦損傷評分為9分，手術等待時間在14以內為最佳手術時機，此時手術時間短，出血量少，術后關節功能恢復好。

【關鍵詞】 股骨髁骨折；顱腦損傷；手術時機；研究

Formulation of Operations'Opportunity for Patients with Femur Condylar Fracture Combined Moderately or Severe Brain Injury

Chen Zhenqiang Zhao Xingwei Zhang Qiang Shi Jianmin Wang Qiang

（Liaocheng People's Hospital，Liaocheng，Shandong，252000）

【Abstract】 Objective To study patients formulation of operations'opportunity with condylar fracture combined moderately severe brain injury. Method From 6 months in 2007 years to 3 months in 2012 years， forty-seven patients with moderately or severe brain injury had received surgery for condylar fracture. Operation way included external fixator （2 cases）， reverse intramedullary nail fixation （3 cases）， dynamic condylar screw fixation（16 cases）， femoral condylar anatomy plate fixation（19 cases）， lag screw or hollow screw fixation（7 cases）. According to GCS at registered time， dividing three groups， the first group ，9-10scores， 17 cases； the second group， 6-8 scores， 20 cases； the third group， less than 5 scores， 10 cases； to statistics each group the average waiting operation time. According to the GCS scores at operation， dividing two groups， the first， more than 9 scores， 37 cases； the second group， 5-8 scores， 10 cases； to statistics each group the average waiting operation time. According to the average waiting operation time， dividing three groups， the first group is less than 14 days； the second group is between 15 and 28 days and the third group is more than 28 days ， to stastics each group average operation time and quantity of incision flow postoperation. Followed 8 months， told the patients take X gray film to reserve the union. Recording the third month knee functions， its functions criteria were formulated according to Shelbourne. Each group had done correlation analytic statistics. Results According to GCS at registered time， every group has respectively waiting operating time 13.4d、24.9d、36.6d； According to the GCS scores at operation， every group has respectively waiting operating time19.6d， 36.6d. According to the average waiting operation time， every group had respectively time， 88.8m、112.6m、152.4m； every group had respectively quantity of incision flow postoperation， 237.6ml、570.8ml、825.3ml. Knees functions divided excellent 12 cases， good 21 cases， fair 6 cases， poor 12 cases. Each group had done correlation analytic statistics and accepted positive correlation. Conclusion it is most optimum operation opportunity at the GCS 9 scores and the waiting operation time 14 days. At the time， operation time was short， less amount of bleeding， the knee function is good after operation.

【Keywords】 femur condylar fracture； brain injury； operation opportunity； research

顱腦損傷合并骨折的患者在國內外都收到普遍的重視，但在手術時機制定上不同部位的骨折還沒有統一執行的臨床標準。……