解剖锁定钢板及髓内钉治疗外踝骨折Danis-weber B及C型骨折比较研究

发布时间：2018-04-07 19:01

本文选题：外踝骨折　切入点：分型　出处：《吉林大学》2017年硕士论文

【摘要】：解剖锁定钢板及髓内钉治疗外踝骨折Danis-weber B及C型骨折比较研究背景:外踝骨折治疗需视为关节内骨折进行治疗,为了尽量减低术后关节僵硬、创伤性关节炎等并发症,治疗原则上需给予骨折处解剖复位、坚强内固定及术后早期功能锻炼。对于外踝骨折存在多种治疗方案及内固定方法,切开复位合并钢板内固定的治疗是常用的治疗方法,手术操作对医师的技术要求不高,可在直视下复位骨折达到解剖复位,但术后并发症相对较高。随着mippo技术理念的深入及内固定材料种类变化,髓内钉治疗外踝骨折提供了新的备选方案,由于其手术要求的切口相对较小,而且术后出现并发症的几率也较小,但对医师的操作技术要求较高,能提供良好的影像学结果和功能恢复。目的:外踝骨折Danis-Weber B及C型骨折,分别采用Synthes解剖锁定钢板及Acumed腓骨髓内钉固定的相关问题进行比较。方法:分析2014年01月—2016年04月在吉林大学第一医院100例外踝骨折分别采用解剖锁定钢板及髓内钉治疗比较。记类采用Danis-Weber分型,针对B及C型外踝骨折,采用解剖锁定钢板60例,采用髓内钉40例,对病例性别、年龄、软组织情况及关节脱位、住院日、手术时间、出血、切口愈合情况、是否合并感染、骨折复位、骨折愈合、踝关节功能等进行观察。结果:两组手术医师分别完成外踝使用Synthes解剖锁定钢板及Acumed髓内钉的患者在性别、年龄、软组织情况及关节脱位等方面差异无统计学意义(P0.05)。平均住院日及骨折愈合时间上差异无统计学意义(P0.05)。骨折复位标准均达到解剖复位。Baird-Jackson踝关节评分在疼痛、行走能力、踝关节稳定、跑步能力、工作能力、踝关节活动范围、X线片评估骨折复位结果及总分上差异无统计学意义(P0.05),手术时间、手术出血量、切口长度、切口并发症等方面有统计学意义(P0.05),由于使用内固定物材料非一种材质及受骨折合并类型影响,住院费暂时无比较意义。结论:在外踝骨折Danis-Weber B及C型骨折中,髓内钉相比解剖锁定钢板是更为高效的办法,能够较少手术出血量及降低手术切口并发症。对于大多数的外踝骨折,切开复位钢板内固定仍然是常规的固定手段,适应症广,能使腓骨远端骨折达到解剖复位,且固定可靠,取得良好的功能恢复,临床操作相对简单,选取钢板为内固定物材料、由于在骨折处行手术切口,受骨折处软组织条件影响较大,术后出现皮缘坏死、钢板外露、甚至感染几率相比髓内针升高。髓内钉为闭合复位,操作技术要求较高,需要一定的硬件设施且术中透视次数较多,骨折复位情况较解剖钢板略差。微创闭合复位利于保护软组织及较少骨膜剥离,减少骨折血运破坏,利于骨折愈合,减少皮肤坏死及感染可能;髓内纵向固定,符合生物力学稳定性,术后早期功能锻炼,二次手术易取出。内固定不适性小,较少要求取出,但最终两组骨折的临床愈合时间以及远期踝关节功能的恢复无明显差异。临床工作中,需要根据患者的经济条件及依从性、软组织条件、骨折类型等具体情况合理选择内固定方法及材料。
[Abstract]:Anatomical locking plate and intramedullary nail in the treatment of Danis-weber type C and B fractures of the lateral malleolus fracture of lateral malleolus: comparative study on background therapy should be treated as intra-articular fracture, in order to minimize postoperative ankylosis, traumatic arthritis and other complications, the treatment principle should be given fracture anatomical reduction, rigid fixation and early postoperative function exercise. For a variety of treatment programs and the methods of internal fixation of lateral malleolus fracture, incision reduction plate fixation is associated with the common treatment, the operation requirements of medical technology is not high, in the direct manipulation of the fracture anatomical reduction, but the complications are relatively high. With the change of type MIPPO technology concept deeply and internal fixation, intramedullary nail in the treatment of lateral malleolus fractures provide new alternatives, because of its relatively small incision operation requirements, and postoperative complications of the few The rate is also smaller, but the operation technology of medical demand is higher, can provide good imaging results and recovery function. Objective: Danis-Weber B lateral malleolus fractures and C fractures, were used to compare Synthes anatomic locking plate fixation nail related problems and Acumed. Methods: the fibular bone marrow of 2014 01 - 04 2016 in No.1 Hospital of Jilin University 100 cases of ankle fractures by anatomical locking plate and intramedullary nail in the treatment of class. Note the Danis-Weber classification, the B and C type lateral malleolus fractures with anatomical locking plate in 60 cases, with an intramedullary nail in 40 cases, the age of patients, gender, soft tissue and joint dislocation, hospitalization days, the operation time, bleeding, wound healing, infection, fracture reduction, fracture healing, ankle joint function were observed. Results: the two groups of surgeons were completed using Synthes lateral anatomical locking plate and Ac Umed intramedullary nail in patients with gender, age, no statistically significant difference between soft tissue and joint dislocation and so on (P0.05). The average hospitalization days and healing time had no significant difference (P0.05). Fracture reduction standard anatomic reduction was achieved in.Baird-Jackson ankle joint scoring ability to walk in pain, and ankle joint stability running ability, work ability, range of motion of the ankle, X-ray evaluation of fracture reduction results and total score difference was not statistically significant (P0.05), operation time, bleeding volume, incision length, incision complications had statistical significance and other aspects (P0.05), due to a non material and by using internal fixation combined with fracture type materials, hospital fees temporarily no comparison significance. Conclusion: Danis-Weber B and C in the lateral malleolus fracture, intramedullary nail with anatomical locking plate is a more efficient method to do, less amount of bleeding The surgical incision and reduce the complications. For most of the lateral malleolus fracture, internal fixation is still fixed conventional means, wide indications, the anatomical reduction of the distal fibula fracture, and fixed reliable, good functional recovery, clinical operation is relatively simple, for selecting plate internal fixation materials, due to the fractures. Surgical incision, fracture by soft tissue conditions affected the edge of skin necrosis after operation, plate exposure, even the infection rate increased. Compared to intramedullary nail intramedullary nail for closed reduction operation, higher technical requirements, need certain hardware facilities and intraoperative fluoroscopy times more reduction slightly worse than the anatomical plate fracture minimally invasive closed reduction. To protect the soft tissue and less periosteal stripping, reduction of blood supply damage, conducive to fracture healing, reduce skin necrosis and infection; intramedullary fixation with longitudinal, biomechanics Stability, early postoperative functional exercise, the two operation easy to remove the internal fixation. The discomfort of small, less demanding out, but in the end of two groups of fracture healing time and long-term ankle function recovery. No significant differences in the clinical work, according to the economic conditions of patients and compliance, soft tissue conditions reasonable selection of internal fixation methods and material fracture type specific circumstances.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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