可吸收内固定材料治疗关节周围骨折的手术技巧研究

发布时间：2018-04-24 20:18

本文选题：可吸收内固定材料 + 关节周围骨折　；参考：《吉林大学》2015年硕士论文

【摘要】：目的：通过可吸收钉对骨折的手术治疗的回顾性分析，探究可吸收内固定物使用的术中注意事项和操作技巧。方法：本文共收集吉林大学中日联谊医院骨科2012年10月-2014年11月收治的关节周围骨折患者26例，均使用可吸收内固定物（可吸收钉、可吸收接骨板、可吸收固定棒）手术治疗。回顾性分析每名患者术前术后的关节功能、手术并发症及影像学资料。其中男，18例，女，8例；年龄19-56岁，平均38.35岁；股骨头骨折7例，内踝骨折5例（其中3例合并外踝骨折，1例合并后踝骨折），胫骨平台骨折2例，外踝骨折2例，距骨骨折4例，肩关节斯脱骨折2例，跖骨骨折2例，，股骨髁撕脱骨折1例，髌骨骨折1例。26例患者有20例有不同程度的复合损伤，及时积极处理合并损伤，于1~2周内行骨折切开复位可吸收内固定器材固定术，术中手术器械、材料配套，根据骨折部位、特点及分型选择与之适应的手术入路,术中充分暴露欲处理的骨折，尽量做到术野清晰且损伤相对较小,必要时可切开关节囊来更好的复位关节面，骨折复位良好后尽量修复关节囊及周围韧带。按照规范操作和符合AO骨折固定原理。手术操作技术规范。术后在医师指导下适当功能锻练，必要时辅以外固定辅助功能锻练。所有患者术前均行高质量数字成像（DR）或关节部位的三维CT及表面重建。术后1-2天内行DR复查，术后1、3、6、12个月复查x线片，4-24个月随访，通过查体、患者反馈资料、及术后定期复查的x线片判断骨折愈合情况，同时记录相应、相关处理方法、并发症及病情转归情况。所有患者均根据美国骨科协会(AAOS)关节功能评价标准,分为4级,优:关节活动正常,无疼痛,生活完全自理;良:关节活动度为75%,轻度疼痛,不影响工作和生活;可:关节活动度为50%,中度疼痛,工作和生活收影响;差:关节活动度5%,剧烈疼痛,明显影响工作和日常生活。将所得术前术后相关资料进行统计学分析。结果:手术过程中：3例患者于手术过程中出现断钉；2例患者于手术过程中出现螺钉对骨折块把持欠佳，螺钉松动；2例患者于手术植钉过程中出现植入阻力过大剩余钉尾无法继续植入。术后：26例患者均术后随访，随访时间4-24个月。大部分患者能按时（术后第1、3、6、12个月）复查，并且电话随访；少部分未能做到，只给予电话随访。其中1例因个人因素未按术后要求,未按医师要求进行复诊和康复锻炼，电话随访无法完全获知其恢复情况，1例患者未按医师要求休养及功能锻练，提前负重下地行走，骨折愈合欠佳，关节功能尚可，建议减少负重，延长随访半年，骨折愈合；2例出现骨折愈合后皮下钉帽未完全吸收，但未引起疼痛及炎性反应，予以切开摘除。其余患者治疗效果良好，创口、骨折愈合良好，对关节功能恢复满意，均能满足日常工作和生活需要。手术前其中2例为可，24例为差。手术后其中1例为可，1例为良，24例为优。优良率96.15%.所有患者术前、术后关节功能评价分级均有提高。结论： 1、可吸收钉适用于关节周围骨折 2、可吸收钉治疗关节周围骨折的优势：无需二次取出、避免应力遮挡、无影像干扰、生物相容性好，无金属组织残留体内 3、应用可吸收内固定物治疗关节周围骨折术中规范操作及相关手术技术是手术成败的关键。
[Abstract]:Objective: through retrospective analysis of the operative treatment of fracture by absorbable screws, to explore the matters needing attention and operative skills in the use of absorbable internal fixators.
Methods: a total of 26 patients with periarticular fractures treated in Department of orthopedics, Jilin University, China Japan Friendship Hospital, November -2014 October 2012, were treated with absorbable internal fixation (absorbable nail, absorbable plate, absorbable fixation rod). The joint function, surgical complications and image of each patient were analyzed retrospectively. Male, 18 cases, women, 8 cases; age 19-56 years old, average 38.35 years; 7 cases of femoral head fracture, 5 cases of internal malleolus fracture (including 3 cases with external malleolus fracture, 1 combined posterior ankle fracture), 2 cases of tibial plateau fracture, 2 cases of fracture of the ankle, 4 cases of talus fracture, 2 cases of shoulder joint fracture, 2 cases of metatarsal fracture, femoral condylar fracture fracture, and fracture of patella. Cases of.26 cases have 20 cases with different degree of complex injury, and timely and active treatment of combined injury, open reduction within 1~2 weeks can absorb internal fixation equipment fixation, surgical instruments, material matching, according to the fracture site, characteristics and classification of the adaptive hand approach, fully exposed fractures in the operation, try to do as much as possible. When the operation field is clear and the injury is relatively small, the joint capsule can be cut to better reposition the articular surface when necessary. The joint capsule and the surrounding ligament are repaired as far as possible after the fracture is good. According to the standard operation and conforming to the AO fracture fixation principle, the operation technical specification. After the operation, the functional training is suitable under the guidance of the doctor, and the auxiliary external fixation auxiliary work is supplemented when necessary. Able to exercise. All patients underwent high quality digital imaging (DR) or three-dimensional CT and surface reconstruction of joints. DR reexamination was performed within 1-2 days after operation, X-ray examination was performed at 1,3,6,12 months after operation, and 4-24 months followed up. Methods, complications and prognosis. All patients were divided into 4 grades according to the American Department of orthopedics Association (AAOS) joint function evaluation criteria, excellent: joint activities were normal, no pain, and life was completely self-care; good: joint activity was 75%, mild pain, no impact on work and life; but joint activity was 50%, moderate pain, work and life harvest. Poor: joint activity 5%, severe pain, obviously affect work and daily life. Preoperative and postoperative data will be statistically analyzed.
Results: during the operation, 3 patients had broken nails during the operation; 2 patients had poor screws on the fracture block and loosened the screws during the operation, and 2 patients were unable to continue implantation during the operation. After the operation, 26 patients were followed up after 4-24 months of follow-up. Some patients could be reexamined on time (1,3,6,12 month after operation) and followed up by telephone; only a few failed to be done and only a follow-up was given. 1 of them were not required to revisit and rehabilitate according to the requirements of the surgeon. The telephone follow-up could not be fully understood, and 1 patients were not required to recuperate and function according to the doctor's request. The fracture healing was not good and the joint function was still available. It was suggested to reduce the weight bearing, prolong the follow-up for half a year and heal the fracture. 2 cases were not completely absorbed by the nail cap after the healing of the fracture, but did not cause the pain and inflammatory reaction. The other patients had good treatment effect, the wound, fracture healing well and joint work. After operation, 2 cases were available and 24 cases were poor. After operation, 1 cases were available, 1 were good, 24 were excellent. The excellent rate of 96.15%. in all patients was improved before operation.
Conclusion:
1, the absorbable nail is suitable for the periarticular fracture
2, the advantages of absorbable screws in the treatment of periarticular fractures: no need for two removal, avoiding stress shielding, no image interference, good biocompatibility, and no residual metal tissue.
3, the application of absorbable internal fixators in the treatment of periarticular fractures is the key to the success or failure of the operation.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【参考文献】