交锁髓内针切开复位内固定治疗下肢长骨骨折疗效分析

发布时间：2018-05-18 18:54

本文选题：有限切开复位 + 闭合复位　；参考：《吉林大学》2015年硕士论文

【摘要】：目的：随着现代生活水平的提高，交通运输及地产建筑业的飞速发展，导致高能量性的损伤越来越多，由于下肢长管状骨解剖结构和其特殊的生理作用，下肢长管状骨骨折也被越来越得到重视。当前医疗水平不断的提高，治疗方式趋于多样化，但我们对于保守治疗失败的下肢长管状骨折仍以手术治疗为主，手术方式的选择以传统的钢板固定及经典髓内固定为主。本文通过对下肢长管状骨折尤其是中段骨折交锁髓内针固定的病例资料进行回顾性分析，通过对比闭合复位与有限切开复位髓内固定治疗下肢长管状骨折的手术时间及骨折愈合时间，探讨交锁髓内针治疗下肢长骨骨折的临床疗效，尤其是下肢长骨B、C型骨折。以期对这种临床上较常见骨折的首次手术方式的选择做出一定的理论指导，减轻患者术中手术时间长及术后长期卧床的痛苦。资料与方法：本文通过回顾性研究2012年4月～2014年8月期间，吉林大学中日联谊医院骨科创伤学组诊治的外伤致下肢长管状骨骨折患者81例，经筛选后得到53例，其中男31例，女21例，其中双股骨中下段骨折1例；年龄23-77岁，，平均47.5岁。入选的标准：53例病例中，因A型骨折术中闭合复位失败，选择有限切开复位交锁髓内针内固定术4例，余均为B、C型骨折中骨块较大且移位明显的患者27例。致伤原因中车祸伤31例，坠落伤11例，挤压伤3例，摔伤8例；其中股骨中上段骨折32例，胫骨中上段骨折21例，多发伤患者24例。按照AO／OTA分类32A型5例，32B型15例，32C型6例，42A型7例，42B型11例，42C型9例。以交锁髓内针有限切开复位内固定术为治疗组，闭合复位术为对照组，平均随访18个月（最短6个月，最长30个月）。所有骨折均为新鲜骨折,多发伤患者局部软组织挫伤均较重，绝大多数患者无明显骨质缺损。手术时间为伤后5小时-3周，术中采取扩髓、静力固定【3】。统计学方法：应用SPSS19.0统计软件分析，计量资料用均数加减标准（X±S）表示，采用t检验，计数资料用χ2检验，以P＜0.05表示差异存在统计学意义。结果：治疗组较对照组手术时间短，术中出血量少。治疗组较对照组骨折愈合时间短，患者术后卧床时间缩短。治疗组与对照组在骨折术后骨不连发生程度上无统计学意义。结论：有限切开复位交锁髓内针内固定术治疗下肢长骨骨折适应AO/OTA分型广泛，且术中髓内针能准确置入并能准确判断骨折复位情况，明显缩短手术时间及减少术中C臂透视引起的损伤，对骨质缺损严重需要植骨的患者能一期给予植骨，减少因二期植骨手术而造成的自身创伤性伤害及患者经济负担重的不良后果，并减少因切口暴露时间长导致的术后感染，同时降低骨筋膜室综合征发生的几率，缩短术后康复时间，是一种稳妥可行的方法。
[Abstract]:Objective: With the improvement of modern living standards and the rapid development of transportation and real estate construction industry, there are more and more high energy injuries due to the anatomical structure of the long tubular bone of the lower extremities and its special physiological function. Long-bone fractures of the lower extremities have also been paid more and more attention. At present, the medical treatment level is improving constantly, the treatment methods tend to be diversified, but we still treat the failure of conservative treatment of lower extremity long tubular fractures mainly by surgical treatment, the choice of surgical methods is the traditional plate fixation and classical intramedullary fixation. In this paper, the data of patients with long tubular fractures of lower extremity, especially those with interlocking intramedullary needle fixation, were analyzed retrospectively. By comparing the operative time and fracture healing time between closed reduction and limited open reduction and intramedullary fixation, the clinical effect of interlocking intramedullary needle in the treatment of lower extremity long bone fracture, especially the lower limb long bone type C fracture, was discussed. In order to make certain theoretical guidance on the choice of the first operation mode of this kind of common fracture in clinic, to alleviate the pain of long operation time and long-term bed-rest after operation. Information and methods: From April 2012 to August 2014, a retrospective study was conducted on 81 cases of lower extremity long bone fractures diagnosed and treated by Department of Orthopedics, Sino-Japanese Friendship Hospital of Jilin University. 53 cases were obtained after screening, including 31 males and 21 females. There was 1 case of double distal femur fracture, aged 23-77 years (mean 47.5 years). Among the 53 cases of type A fracture, 4 cases were treated with limited open reduction and interlocking intramedullary needle fixation because of the failure of closed reduction in type A fracture. The rest were 27 cases with large bone mass and obvious displacement in type B C fracture. The causes of injury included 31 cases of traffic accident, 11 cases of falling injury, 3 cases of crush injury, 8 cases of falling injury, including 32 cases of middle and upper femur fracture, 21 cases of middle and upper tibia fracture, 24 cases of multiple injury. According to AO/OTA classification, there were 5 cases of type 32A, 15 cases of type 32B, 6 cases of type 32C, 7 cases of type 42A, 11 cases of type 42B, 9 cases of type 42C. The treatment group was treated with limited open reduction and internal fixation with interlocking intramedullary needle and the control group with closed reduction. The average follow-up was 18 months (the shortest 6 months and the longest 30 months). All the fractures were fresh, the local soft tissue contusion was serious in the patients with multiple injuries, and there was no obvious bone defect in most of the patients. The operative time was 5 hours-3 weeks after injury. Reaming and static fixation were performed during the operation. Statistical methods: The statistical software of SPSS19.0 was used to analyze the statistical data. The statistical data were expressed by the standard of mean addition and subtraction (X 卤S), the t test was used, the count data was analyzed by 蠂 2 test, and the difference was statistically significant (P < 0. 05). Results: The time of operation in the treatment group was shorter than that in the control group, and the amount of intraoperative bleeding was less. The healing time of fracture in the treatment group was shorter than that in the control group, and the bed-rest time of the patients after operation was shorter. There was no significant difference in the degree of nonunion after fracture between the treatment group and the control group. Conclusion: Limited open reduction and interlocking intramedullary needle fixation for lower extremity long bone fractures adapted to a wide range of AO/OTA classification, and intramedullary needle can be placed accurately and can accurately judge the reduction of fractures. The operative time was significantly shortened and the injury caused by C-arm fluoroscopy was reduced during the operation. Bone grafts could be given to patients with serious bone defect who needed bone grafting in one stage. To reduce the self-traumatic injury caused by secondary bone grafting and the adverse consequences of heavy financial burden on the patients, and to reduce the postoperative infection caused by the long time of incision exposure, and to reduce the probability of occurrence of osseous fascia syndrome. Shortening the time of postoperative rehabilitation is a safe and feasible method.
【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

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