传统髓内钉与髌上入路髓内钉在治疗胫骨近端骨折中的疗效分析

发布时间：2018-02-13 06:57

  本文关键词： 胫骨近端骨折 髓内钉 内固定　出处：《大连医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:比较传统髌下入路髓内钉与新型META-NAIL髌上入路髓内钉在治疗胫骨近端骨折中的骨折复位精确度、膝关节功能的优良率以及骨折愈合时间等方面疗效的比较。方法收集2012年1月~2013年11月至我院就诊的46例胫骨近端骨折病例,按治疗方法分为传统髌下入路髓内钉治疗组(对照组)23例和新型META-NAIL髌上入路髓内钉治疗组(实验组)23例,对比分析两组患者手术时间、住院时间、骨折临床愈合时间和骨性愈合时间以及通过CT影像比较术后两组患者胫骨骨折处的冠状位及矢状位的轴线成角、移位及肢体短缩情况等临床相关数据。所有患者全部行闭合复位,闭合性骨折的患者术后抗生素使用24h,开放性骨折经清创后,应用抗生素3~5天,适量应用脱水药物,待肿胀消退后行手术治疗。张力性水泡的患者,给予脱水药物静滴配合浸润硫酸镁溶液的纱布覆盖小腿,待水泡消退后再行手术治疗。患者内固定术后使用抗生素使用不超过72h,术后2d即应用CPM机辅助训练,有利于早期恢复膝关节功能,同时可预防下肢静脉血栓。结果全部46例均获随访,平均随访时间14±3.5个月(11~18个月),切口均一期愈合。患者术后均行CT检查,通过测量后提示两组患者术后冠状位成角(对照组3.6°±2.8°、实验组3.8°±2.4°)、矢状位移位(对照组1.0±3.4mm、实验组1.2±4.5mm)及冠状位移位(对照组1.3±5.6mm、实验组1.1±3.9mm)无显著性差异(P0.05)。实验组矢状位成角(对照组4.9°±3.3°、实验组2.5°±1.6°)、肢体短缩(对照组1.3±5.6mm、实验组1.1±3.9mm)较对照组小(P0.05)。两组手术时间、住院时间、骨折愈合时间两组未见显著性差异(P0.05),见表2。按Rasmussen膝关节功能评分标准评定临床效果,包括疼痛、行走能力、伸膝、关节活动度和稳定性等5项内容,各6分,优≥27分,良20~26分,可10~19分,差6~9分。实验组优良率为91.3%与对照组78.3%相比差异有显著性差异(P0.05)。统计学处理采用SPSS12.0软件,计数资料以率表示,组间比较进行X2检验,计量资料以均数±标准差(x±s)表示,组间比较进行t检验。P0.05为差异,有统计学意义。结论在本研究中,我们比较了传统髓内钉和髌上入路髓内钉治疗胫骨近端骨折的临床数据,结果显示:两组患者术后冠状位成角、矢状位移位及冠状位移位无明显差异(P0.05),实验组矢状位成角及肢体短缩较对照组小,差异有统计学意义(P0.05),这恰恰证实了髌上入路髓内钉的优势,即其对骨折前方成角的牵引力很小,理论上将导致预后效果更佳;两组手术时间、住院时间无显著差异,实验组骨折愈合时间明显较对照组短,差异显著(P0.05),说明在实际应用中,两者都能够获得满意的骨折愈合效果;实验组膝关节功能评价优良率为91.3%,明显高于对照组的78.3%,差异有统计学意义(P0.05),由于Rasmussen膝关节功能评分标准包括疼痛、行走能力、伸膝、关节活动度和稳定性等5项内容,是一种较全面的来自患者主诉的功能评分,实验组髌上入路髓内钉由于其设计的独特性,随访中髌前痛等并发症少,患者依从性和耐受性好,满意度较高,可能是由于两组未出现深部感染、下肢深静脉血栓、内固定失效等并发症但实验组仍评分较高的原因。由此可见,髌上入路髓内钉较传统髓内钉是存在一定优势的。本研究中的矢状位成角及肢体短缩的数据在两组间存在显著性差异但却并未影响到后续观察的骨折愈合结果(即两组都获得了满意的骨愈合结局),但若在后续研究中进一步扩大样本量并延长随访时间,这种影响是否依然存在(即矢状位成角及肢体短缩的差异导致骨愈合的差异),尚需要进一步观察。从临床角度来讲,尽可能地获得满意的复位和恢复病骨初始角度依然是医师们手术操作的期望。综上所述,对于治疗胫骨近端骨折,髌上入路髓内钉作为一种较新的髓内固定器械,疗效满意,值得推广。
[Abstract]:Objective: To compare the traditional approach of infrapatellar intramedullary nail and new META-NAIL patellar approach intramedullary nail in the treatment of proximal tibial fractures in fracture reduction accuracy, excellent rate of knee joint function and fracture healing time and curative effect. Methods 46 cases of tibial ~2013 collected from January 2012 November to our hospital in fracture cases, according to the treatment methods are divided into the traditional approach of infrapatellar intramedullary nail treatment group (control group) and 23 cases of the new META-NAIL suprapatellar intramedullary nail way into treatment group (experimental group) 23 cases, analysis of hospitalization time of two groups of patients with operation time, contrast, fracture healing time and bone healing time and the CT images were compared two groups of patients after tibial fracture at the coronal and sagittal axis angle, displacement and limb shortening and other clinical data. All patients underwent closed reduction, closed fracture patients with postoperative antibiotics The use of 24h, open fractures after debridement, antibiotic 3~5 days, the amount of application of dehydration drugs until the swelling subsided after surgery. Blisters were treated with dehydration drugs intravenously with infiltration of Magnesium Sulfate solution gauze to cover the calf, until the blisters subsided after surgery. Patients after internal fixation with antibiotics use no more than 72h, 2D after application of CPM assisted training is conducive to the early recovery of knee joint function, and can prevent venous thrombosis. Results all 46 cases were followed up, the mean follow-up time was 14 + 3.5 months (11~18 months), incision healed. The patients were examined by CT after that, through the measurement of two groups of patients with postoperative coronal angle (control group 3.6 degrees plus or minus 2.8 degrees, the experimental group 3.8 degrees - 2.4 degrees), sagittal displacement (control group experimental group 1 + 3.4mm, 1.2 + 4.5mm) and coronal shift (control group 1.3 + 5.6mm, experimental group 1.1. 3.9mm)鏃犳樉钁楁，

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