手法复位两种固定方式治疗胫腓骨不稳定性骨折的临床疗效观察

发布时间：2018-03-31 15:33

本文选题：手法复位　切入点：胫腓骨骨折　出处：《福建中医药大学》2017年硕士论文

【摘要】：目的:通过探讨手法复位带锁髓内钉固定与单臂式外固定支架固定治疗胫腓骨不稳定性骨折的临床疗效,寻求一种疗效可靠、适宜推广的胫腓骨不稳定性骨折的治疗方法。方法:选取60例符合纳入标准的胫腓骨不稳定性骨折病例,随机分为治疗组(30例,采用手法复位带锁髓内钉固定)和对照组(30例,采用手法复位外固定支架固定),两组病例术后常规用药。对两组的手术方式的术中出血量、骨折的愈合时间、术后感染以及骨折愈合后疗效评价方面进行比较,并作统计学处理。结果:随访6～12个月,所有骨折均一期愈合,骨折愈合时间12～26周,平均18.7周。治疗组与对照组的手术时间及术中出血量的比较,无显著性差异(P0.05);骨折愈合时间比较,治疗组16.06±2.70周,对照组19.06±4.09周,两组骨折愈合时间有显著差异(P0.05);骨折术后感染方面,治疗组感染无感染病例,对照组有2例发生浅表感染,两组病例均未发生深部感染。对照组感染率为6.7%,统计分析,两组的感染率无统计学意义(P0.05),单就百分比而言,外谷底支架组高于髓内钉组,感染病例均行二次清创术,术后给予敏感抗生素治疗,定期伤口更换辅料,创面均愈合。骨折愈合后疗效评价方面,两组都采用Johner-Wruhs评分及Mazur踝关节评分系统评估患者骨折愈合。Johner-Wruhs评分治疗组的优良率为:93.3%,对照组的优良率为:96.7%;Mazur踝关节评分治疗组为优良率为:93.3%,对照组优良率为:90.0%,两组Johner-Wruhs评分及Mazur踝关节评分比较P0.05,无统计学意义,两组骨折愈合后的疗效无显著差异。结论:手法复位带锁髓内钉固定和外固定支架固定都是治疗胫腓骨不稳定性骨折的有效方法,两者都有创伤小,愈合率高等优点。但带锁髓内钉治疗胫腓骨骨折具有固定牢靠,骨折愈合时间短,感染率低等优点。外固定支架虽然操作简单,创伤小,拆除外固定支架无需二次手术,但钉孔感染的发生率较高。
[Abstract]:Objective: to explore the clinical effect of manipulative reduction and interlocking intramedullary nail fixation and single arm external fixation in the treatment of unstable tibia and fibula fracture.Methods: sixty cases of unstable fracture of tibia and fibula were randomly divided into treatment group (n = 30) and control group (n = 30).Manual reduction and external fixation were used to fix the stents, and the patients in both groups were treated routinely after operation.The amount of intraoperative bleeding, the time of fracture healing, postoperative infection and the evaluation of curative effect after fracture healing were compared between the two groups, and statistical analysis was made.Results: all the fractures were healed at the first stage for 6 ~ 12 months. The healing time was 1226 weeks (mean 18.7 weeks).There was no significant difference in operative time and intraoperative bleeding between treatment group and control group (P 0.05), fracture healing time was 16.06 卤2.70 weeks in treatment group and 19.06 卤4.09 weeks in control group.There were no infection cases in the treatment group, 2 cases in the control group, and no deep infection in both groups.The infection rate in the control group was 6.7. The infection rate in the two groups was not statistically significant (P 0.05). In terms of percentage, the rate of infection in the outer-floor stent group was higher than that in the intramedullary nail group, the infection cases were treated with secondary debridement, and the patients were treated with sensitive antibiotics after operation.The wounds were healed when the excipients were changed regularly.The evaluation of curative effect after fracture healing,Both groups were evaluated by Johner-Wruhs score and Mazur ankle scoring system. Johner-Wruhs score was used to evaluate fracture healing. The excellent and good rate in the treatment group was 10: 93. 3, the excellent and good rate in the control group was 96. 7%. The excellent and good rate in the control group was 9. 93. 3%. The excellent and good rate in the control group was 9. 0. The excellent and good rate in the control group was 9. 90.There was no significant difference between Johner-Wruhs score and Mazur ankle score (P 0.05).There was no significant difference in the effect of fracture healing between the two groups.Conclusion: manipulative reduction and interlocking intramedullary nail fixation and external fixation are effective methods for the treatment of unstable tibia and fibula fractures, both of which have the advantages of small trauma and high healing rate.But the treatment of tibiofibular fracture with interlocking intramedullary nail has the advantages of firm fixation, short healing time and low infection rate.Although the external fixator is simple in operation and less traumatic, it does not require secondary operation to remove the external fixator, but the incidence of nail hole infection is high.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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