Objective: To explore the early effectiveness and advantages of mini-Swashbuckler approach in treatment of distal femoral type C fractures by comparing with Swashbuckler approach.
Methods: A retrospective analysis was made on 43 patients with distal femoral type C fractures between January 2014 and June 2018. Twenty-two patients were treated with open reduction via mini-Swashbuckler approach and internal fixation with less invasive stabilization system (LISS) plate in modified group; and 21 patients were treated with open reduction via Swashbuckler approach and internal fixation with LISS plate in traditional group. There was no significant difference in age, gender, cause of trauma, fracture classification, fracture side, interval between injury and operation, and complications between the two groups ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, hospitalization time, fracture healing time, Hospital for Special Surgery (HSS) scores of the knee, and postoperative complications were recorded and compared between the two groups.
Results: The operation successfully completed in both groups. The operation time of the modified group was significantly longer than that of the traditional group, the fluoroscopy times was increased and the blood loss was reduced, the differences were significant ( P<0.05). There was no significant difference in hospitalization time between the two groups ( t=0.277, P=0.783). All patients in the two groups were followed up 6-8 months, with an average of 7.2 months. Fractures healed in both groups, there was no significant difference in healing time between the two groups ( t=0.861, P=0.394). The HSS scores of the modified group were 82.91±2.88 and 89.28±3.63 at 3 and 6 months after operation, respectively, which were superior to those of the traditional group (74.62±3.64) and (81.48±4.55) ( t=8.306, P=0.000; t=6.231, P=0.000). There was 1 case of incision infection, 1 case of deep vein thrombosis, and 2 cases of knee flexion and extension dysfunction in traditional group, and 1 case of deep vein thrombosis, 1 case of varus deformity, and 1 case of internal fixation loosening in modified group. There was no significant difference in the incidences of complications between the two groups ( P>0.05).
Conclusion: Compared with Swashbuckler approach, mini-Swashbuckler approach has limited visual field exposure, which leads to prolonged operation time and increased fluoroscopy times, but the risks of complications do not increase. Because of its small soft tissue injury and less blood loss, it is conducive to the recovery of knee joint function after operation.
目的: 通过与 Swashbuckler 入路比较，探讨 mini-Swashbuckler 入路治疗股骨远端 C 型骨折的早期疗效及优势。.
方法: 回顾分析 2014 年 1 月—2018 年 6 月收治且符合选择标准的 43 例股骨远端 C 型骨折患者临床资料。其中，22 例采用 mini-Swashbuckler 入路联合股骨外侧微创内固定系统（less invasive stabilization system，LISS）钢板治疗（改良组），21 例采用 Swashbuckler 入路联合股骨外侧 LISS 钢板治疗（传统组）。两组患者年龄、性别、致伤原因、骨折分型、骨折侧别、受伤至手术时间、合并症等一般资料比较，差异均无统计学意义（ P>0.05）。比较两组患者手术时间、术中失血量、术中透视次数、住院时间、骨折愈合时间、膝关节功能美国特种外科医院（HSS）评分，以及术后并发症发生情况。.
结果: 两组均顺利完成手术。改良组手术时间较传统组明显延长，术中透视次数增加，失血量减少，差异均有统计学意义（ P<0.05）；两组住院时间差异无统计学意义（ t=0.277， P=0.783）。两组患者均获随访，随访时间 6～8 个月，平均 7.2 个月。两组骨折均愈合，愈合时间差异无统计学意义（ t=0.861， P=0.394）。改良组术后 3、6 个月 HSS 评分分别为（82.91±2.88）、（89.28±3.63）分，均优于传统组的（74.62±3.64）、（81.48±4.55）分，差异均有统计学意义（ t=8.306， P=0.000； t=6.231， P=0.000）。术后传统组发生切口感染 1 例、下肢深静脉血栓形成 1 例、膝关节屈伸功能障碍 2 例，改良组发生下肢深静脉血栓形成 1 例、膝关节内翻畸形 1 例、内固定物松动 1 例，两组各并发症发生率差异均无统计学意义（ P>0.05）。.
结论: 与 Swashbuckler 入路相比，mini-Swashbuckler 入路虽视野暴露有限，导致手术时间延长及术中透视次数增加，但术后并发症发生风险未增加；由于其软组织损伤小，手术失血量少，有利于患者术后早期功能锻炼及膝关节功能恢复。.
Keywords: Distal femoral fracture; Swashbuckler approach; internal fixation; less invasive stabilization system plate; mini-Swashbuckler approach.