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目的：探讨比较运用逆行可膨胀髓内钉与股骨远端锁定钢板治疗股骨远端33A、33C1 型骨折的疗效。方法：对2013 年3 月至2015 年6 月收治并符合纳入标准的43 例股骨远端33A、33C1 型骨折患者进行回顾性研究。按照不同的手术固定方式分为逆行可膨胀髓内钉组（n=18）和锁定钢板组（n=25），记录并比较两组手术时间、失血量、愈合时间及功能结果、术中及术后并发症。结果：所有骨折最终都获得愈合；逆行可膨胀髓内钉组在手术时间及失血量上都显著低于锁定钢板组，两组在愈合时间及功能评定方面无明显差异；5 例开放性骨折的患者中1 例出现浅表伤口感染，1例患者延迟愈合。结论：股骨远端逆行可膨胀髓内钉在获得与锁定钢板相当的骨折愈合时间及患肢功能的情况下，具有操作简单、手术时间短、失血量少等特点，对于股骨远端33A、33C1 型骨折来说是一个较好的选择。

英文摘要:

Objective:To compare the effectiveness of Retrograde Expandable Nail (REN) and locking plate ( LP) for the treatment of AO 33A, 33C1 distal femoral fractures.Methods:We retrospectively analyzed 43 patients with distal femoral fractures from March 2013 to June 2015. 18 were fixated with REN and 25 with LP. The 2 groups were compared with respect to operation time, amount of estimated blood loss, healing time and HSS knee scores, and intra- and postoperative complications.Results:All the fractures eventually united retrograde Expandable Nail performed better than locked nailing in operation time, amount of estimated blood loss (P<0.001). There was no difference in fracture union time and HSS knee scores. One of the five patients with open fractures had superficial wound infections, delayed healing in one patient.Conclusion:This study demonstrate that the retrograde femoral expandable nail approach yields comparable fracture union time and extremity function outcome with locking plate fixation. While it allows for an easier management, shorter operating time and lesser estimated blood loss. Making the retrograde expandable femoral nail a reasonable alternative for treating distal femur typesA and C1 fractures.

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