螺纹弹性髓内钉与钢板治疗锁骨骨折的比较

发布时间：2018-04-03 01:01

本文选题：锁骨　切入点：骨折　出处：《天津医科大学》2017年硕士论文

【摘要】：目的对比螺纹弹性髓内钉(Threaded Elastic Intramedullary Nail,TEIN)和重建钢板治疗锁骨中段骨折(Displaced Midshaft Clavicle Fracture,DMCF)的临床应用效果。方法回顾性分析2010年1月至2013年1月间于天津医科大学第四中心临床学院骨一科收治的77例锁骨骨折病人。接受螺纹弹性髓内钉内固定治疗的为实验组,45例;接受重建钢板内固定治疗的为对照组,32例。收集患者临床资料:性别、年龄、患侧、骨折分型、治疗方式、手术时间、随访期限、并发症情况、内置物取出时间、肩关节DASH评分和Constant评分。对收集的资料进行正态性检验,如果计量资料符合正态分布,或近似于正态分布,可以使用Student’s T检验方法,以均值±标准差的形式记录。如果计量资料不符合正态分布,则使用秩和检验分析,以中位数(四分位数间距)的形式记录。计数资料使用绝对值(百分比)的形式记录,使用c2卡方检验和Fisher确切概率法分析。使用SPSS软件(17.0,美国)进行数据的统计学处理,检验水准均取双侧a=0.05。结果1.钢板组患者平均年龄42.2岁(28-61岁),髓内钉组患者平均年龄39.4岁(18-65岁),两组患者年龄均符合正态分布,两组差异没有统计学意义。2.受伤的机制主要有:摔倒、运动损伤、车祸、自行车跌落,两组患者各种骨折发生机制的发生率差异没有统计学意义。3.采用OTA骨折分型,两组患者间A型、B型骨折占比之间的差异没有统计学意义。4.两组患者手术时间符合正态分布,髓内钉组比钢板组的手术时间短(36.93±8.32分VS 56.91±7.77分),组间差异有统计学意义;两组患者X线暴露时间符合正态分布,髓内钉组X线暴露时间比钢板组久(8.32±1.93秒VS6.70±1.17秒),组间差异有统计学意义;两组患者失血量使用秩和检验,髓内钉组出血量比钢板组少(25.00 ml VS 122.50 ml),差异有统计学意义;两组患者骨愈合时间使用秩和检验,髓内钉组骨愈合时间比钢板组短(12.00周VS13.50周),差异有统计学意义。5.钢板组与髓内钉组术后各种并发症的发生率组间差异没有统计学意义。髓内钉组肩关节Constant评分在术后1个月、3个月、6个月时,比钢板组肩关节Constant评分优秀,组间差异有统计学意义。髓内钉组肩关节DASH评分在术后1个月、3个月、6个月时,比钢板组肩关节DASH评分更佳,组间差异有统计学意义。术后12个月时,两组间DASH评分和Constant评分差异均没有统计学意义。髓内钉组所有患者均于术后取出内固定物,而钢板组有18例(56%)患者取出了内固定物。结论螺纹弹性髓内钉的微创术式与钢板内固定术相比,操作简便、创伤小、理想复位、可靠固定、早期恢复功能、缩短愈合时间、减少术后并发症、避免二次住院手术,减少患者身心及经济负担,手术难度不大,适于基层医院推广使用。
[Abstract]:Objective to compare the clinical effects of threaded Elastic Intramedullary Nailtein and reconstruction plate in the treatment of displaced Midshaft Clavicle FractureMMC.Methods from January 2010 to January 2013, 77 patients with clavicle fracture were retrospectively analyzed.45 cases of experimental group were treated with screw elastic intramedullary nail and 32 cases of control group were treated with internal fixation of reconstructed plate.The clinical data of the patients were collected: sex, age, affected side, fracture classification, treatment method, operation time, follow-up period, complications, removal time of implant, shoulder DASH score and Constant score.If the measured data conform to normal distribution or approximate normal distribution, Student's T test method can be used to record the data in the form of mean 卤standard deviation.If the measurement data do not conform to the normal distribution, rank sum test analysis is used and recorded in the form of median (quartile spacing).The count data were recorded in absolute value (percentage) and analyzed by using c 2 chi-square test and Fisher exact probability method.SPSS software 17. 0, USA) was used to process the data, and the test level was 0. 05% on both sides.Result 1.The mean age of the patients in the plate group was 42.2 years old, and that in the intramedullary nail group was 39.4 years old and 18-65 years old. The age of the two groups was normal distribution, and there was no significant difference between the two groups.The main injury mechanisms are: fall, sports injury, car accident, bicycle fall, the two groups of patients with various fracture mechanisms have no statistical significance. 3.According to OTA classification, there was no significant difference between the two groups in the proportion of type A and B fractures.The operative time in the intramedullary nail group was 36.93 卤8.32 minutes vs 56.91 卤7.77 minutes, the difference between the two groups was statistically significant, the X-ray exposure time of the two groups was normal distribution, the operative time of the intramedullary nail group was 36.93 卤8.32 minutes vs 56.91 卤7.77 minutes.The X-ray exposure time of the intramedullary nail group was 8.32 卤1.93 seconds VS6.70 卤1.17 seconds, the difference was statistically significant, the blood loss of the two groups was measured by rank sum test, the blood loss in the intramedullary nail group was 25.00 ml vs 122.50 ml less than that in the plate group, and the difference was statistically significant.The bone healing time of the two groups was shorter than that of the steel plate group by rank sum test, and the difference was statistically significant (P < 0.05).There was no significant difference in the incidence of postoperative complications between plate group and intramedullary nail group.The Constant score of shoulder joint in intramedullary nail group was better than that in plate group at 1 month, 3 months and 6 months after operation, and the difference was statistically significant.The DASH score of shoulder joint in intramedullary nail group was better than that in plate group at 1 month, 3 months and 6 months after operation, and the difference was statistically significant.At 12 months after operation, there was no significant difference in DASH score and Constant score between the two groups.All patients in the intramedullary nail group removed the internal fixation after operation, while 18 patients in the plate group took out the internal fixation.Conclusion compared with plate internal fixation, the minimally invasive screw screw has the advantages of simple operation, less trauma, ideal reduction, reliable fixation, early recovery, shorter healing time, less postoperative complications and less secondary hospitalization.To reduce the physical, mental and economic burden of patients, the operation is not difficult, suitable for grass-roots hospitals to promote the use.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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