Cable-pin与张力带系统治疗闭合性粉碎型髌骨骨折的前瞻性研究

发布时间：2018-05-26 01:02

本文选题：粉碎型髌骨骨折 + Cable-pin系统AO张力带系统　；参考：《山东中医药大学》2017年硕士论文

【摘要】：目的:前瞻性地探讨及比较Cable-pin和张力带系统两种方式治疗闭合性粉碎型髌骨骨折的临床疗效分析。以便获取治疗闭合性粉碎型髌骨骨折的临床疗效的最佳手术方案,并为临床手术方案提供全面的参考。方法:根据提前设计好的临床试验方案,依据纳入排除标准,筛选山东中医药大学附属医院骨科病房自2015年3月至2016年3月期间收治的闭合性粉碎型髌骨骨折患者符合标准的62例病例,随机分为A、B两组,其中A组患者为观察组,B组患者为对照组,A组患者选用Cable-pin系统,B组患者选用张力带系统,同时AB两组患者在住院过程中均行中药辅助疗法。观察组和对照组患者分别于术后15天、30天、60天、90天、120天随访,复查行临床体格检查及膝关节正侧位片,采用改良Bostman髌骨骨折临床疗效评估标准,分别从膝关节活动范围、疼痛、工作、股四头肌萎缩、助行、渗出、打软腿、上下楼梯,并填写随访患者回访表。结果:(1)在作为本次研究对象的62例患者中,均进行了随访,在此期间,皆达到骨折的临床愈合标准。(2)术后120天观察组A组患者Bostman评分平均82.57±9.20分,其中优15例,良13例,中3例,差0例,优良率为90.32%;B组患者Bostman评分平均73.90±14.26分,其中优14例,良11例,中3例,差3例,优良率为80.65%,膝关节功能评分A组高于B组8.67分,优良率A组高于B组9.67%。组间差异采用卡方检验,P=0.046,有统计学意义。(3)在手术时间,固定难易程度、愈合时间方面无明显差异(4)在术后随访,功能活动和并发症方面,A组优于B组,有统计学意义。结论:综合以上具体数据,Cable-pin系统和张力带系统治疗粉碎型髌骨骨折均获得良好效果,在手术持续时间和患者术后愈合时间无明显差异,然根据其术后并发症,膝关节活动功能以及依据Bostman评分标准,Cable-pin系统治疗相对较好,但其价格相对较高,因此我们应当结合患者实际情况,综合评判,征得患者同意,实施较为合理、全面的最佳方案。
[Abstract]:Objective: to explore and compare the clinical efficacy of Cable-pin and tension band system in the treatment of closed comminuted patella fracture. In order to obtain the best surgical treatment of closed comminuted patella fracture, and to provide a comprehensive reference for clinical operation. Methods: according to the clinical trial plan designed in advance, according to the inclusive exclusion criteria, From March 2015 to March 2016, 62 cases of closed comminuted patella fracture in orthopedic ward of affiliated Hospital of Shandong University of traditional Chinese Medicine were selected. Group A was the observation group, group B was the control group, group A selected the Cable-pin system and group B selected the tension band system. Meanwhile, the AB group were treated with Chinese medicine adjuvant therapy in the course of hospitalization. The patients in the observation group and the control group were followed-up 15 days, 30 days, 60 days, 90 days and 120 days after operation. The patients in the observation group and the control group were followed up with clinical physical examination and lateral film of knee joint respectively. The modified Bostman criteria for evaluating the clinical efficacy of patellar fracture were adopted, respectively, from the range of knee joint movement and pain. Work, quadriceps femoris atrophy, walking aid, exudation, soft legs, up and down stairs, and fill in follow-up visit form. Results in the 62 patients who were the subjects of this study, all the patients were followed up. During this period, all of them met the standard of fracture healing. The average Bostman score of group A was 82.57 卤9.20 days after operation, including excellent 15 cases, good 13 cases, fair 3 cases, the average value of Bostman in group A was 82.57 卤9.20 days after operation. The average Bostman score of group B was 73.90 卤14.26, including excellent 14 cases, good 11 cases, fair 3 cases, poor 3 cases, excellent and good rate 80.65. The knee joint function score of group A was higher than that of group B 8.67, and the excellent and good rate of group A was higher than that of group B 9.67. There was no significant difference in operation time, fixation difficulty and healing time between the two groups (P < 0.01). 4) Group A was superior to group B in terms of postoperative follow-up, functional activity and complications. Conclusion: the treatment of comminuted patellar fracture with Cable-pin system and tension band system has good results. There is no significant difference in the duration of operation and the time of healing after operation, but according to the postoperative complications, there is no significant difference in the treatment of comminuted patellar fracture. The treatment of knee motion function and Cable-pin system according to Bostman scoring criteria is relatively good, but its price is relatively high. Therefore, we should combine the actual situation of patients, comprehensive evaluation, with the consent of patients, the implementation of a more reasonable and comprehensive best plan.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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