三种内固定材料固定髋臼骨折的基础与临床对比研究

发布时间：2018-03-24 00:10

本文选题：三种　切入点：固定　出处：《新乡医学院》2015年硕士论文

【摘要】：背景：髋臼骨折为常见的严重创伤,其类型复杂,手术复位及内固定难度大,其疗效及预后与复位治疗关系密切,因此理想的内固定方式是获得治疗髋臼骨折满意疗效的基础。目前国内外对髋臼骨折的研究主要集中比较治疗效果及其影响因素、影像学技术等、术后并发症的防治等,但对髋臼骨折生物力学的研究国内外相对较少。目的：通过回顾性分析,观察不同内固定治疗髋臼关节骨折的临床疗效及评价不同内固定方法的生物力学,以为临床治疗髋臼骨折提供参考。方法：选择2011年1月～2013年12月选择在我院治疗的髋臼骨折患者120例为研究对象,根据内固定方式不同进行分组,分为重建钢板组、解剖型锁定钢板组和记忆合金接骨器组,每组患者40例,于术后3-24个月进行随访,采用Matta功能评定标准,随访时嘱病人进行影像学检查,按X线评价标准和临床标准评估三种不同内固定方式治疗髋臼关节的临床疗效。取新鲜尸体骨盆标本的髋臼关节模拟髋臼骨折进行体外力学实验,测定不同应力分布髋臼与股骨头之间接触面积、骨折面之间的位移变化和髋臼周围应力分布。结果：从手术记录中统计,重建钢板组术中平均用时为(223.27±34.82)min、解剖型锁定钢板组术中平均用时为(236.12±41.22)min和记忆合金接骨器组术中平均用时为(182.62±29.17)min,三组术中平均时间比较,t=-6.494,P0.05,差异具有统计学意义,且记忆合金接骨器组术中平均时间最短。重建钢板组术中出血量为(838.28±59.38)ml、解剖型锁定钢板组术中平均出血量为(938.20±63.25)ml和记忆合金接骨器组术中平均出血量为(549.17±23.48)ml,三组术中平均出血量比较,t=7.372,P0.05,差异具有统计学意义,且记忆合金接骨器组术中出血量最少。统计术后x线片复位优良率,与后期随访作对比。随访3-24个月,重建钢板组按Matta疗效标准中临床标准的疗效及格率为75.00%,解剖型锁定钢板组及格率为87.50%；记忆合金接骨器组及格率为97.50%,三组及格率比较,χ2=13.481,P0.05,差异具有统计学意义,且记忆合金接骨器组及格率最高。重建钢板组按Matta疗效标准中X线标准的疗效及格率为72.50%,解剖型锁定钢板组及格率为85.00%,记忆合金接骨器组及格率为92.50%,三组疗效及格率比较,χ2=12.282,P0.05,差异具有统计学
[Abstract]:Background: acetabular fracture is a common severe trauma, its type is complex, surgical reduction and internal fixation is difficult, its curative effect and prognosis are closely related to reduction and treatment. Therefore, the ideal internal fixation method is the basis of satisfactory curative effect for acetabular fractures. At present, the research on acetabular fractures at home and abroad is mainly focused on the comparison of therapeutic effects and influencing factors, imaging techniques, prevention and treatment of postoperative complications, and so on. But the biomechanics of acetabular fracture is relatively few at home and abroad. Objective: to observe the clinical effect of different internal fixation for acetabular fracture and to evaluate the biomechanics of different internal fixation methods. Methods: 120 cases of acetabular fractures treated in our hospital from January 2011 to December 2013 were divided into two groups according to different internal fixation methods. 40 patients in each group were followed up 3 to 24 months after operation. Matta functional evaluation criteria were used. The patients were asked to perform imaging examination during the follow-up period, and 40 patients in the anatomic locking plate group and the memory alloy osteojunction group were followed up for 3 to 24 months after operation. The clinical efficacy of three different internal fixation methods in the treatment of acetabular joint was evaluated according to X-ray evaluation standard and clinical standard. The acetabular joint simulated acetabular fracture of fresh cadaveric pelvis was taken for in vitro mechanical experiment. The contact area between the acetabular and femoral head, the displacement between the fracture surface and the stress distribution around the acetabular were measured. The average intraoperative time of reconstruction plate group was 223.27 卤34.82 minutes, that of anatomic locking plate group was 236.12 卤41.22)min, and that of memory alloy bone connector group was 182.62 卤29.17 minutes. The mean intraoperative blood loss was 838.28 卤59.38 ml in the reconstruction plate group, 938.20 卤63.25)ml in the anatomic locking plate group and 549.17 卤23.48 ml in the memory alloy connector group. The average blood loss was 7.372g / kg P 0.05, and the difference was statistically significant. In the memory alloy osseograft group, the intraoperative bleeding was the least. The excellent and good rate of X-ray reduction after operation was compared with that of the later follow-up. The follow-up period was 3 to 24 months. According to the clinical standard of Matta, the pass rate of reconstruction plate group was 75.00, the pass rate of anatomic locking plate group was 87.50, the pass rate of memory alloy osteojunction group was 97.50 and the pass rate of the three groups was 13.481g P 0.05, the difference was statistically significant. The pass rate of the reconstruction plate group was 72.50 according to the Matta curative effect standard, the passing rate of the anatomical locking plate group was 85.00, the memory alloy bone connector group was 92.50 and the third group was effective. The difference was statistically significant (蠂 2 + 12.282%, P 0.05).
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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