髓内钉与钢板治疗腓骨远端骨折的临床比较

发布时间：2018-05-28 15:44

本文选题：骨折 + 腓骨远端　；参考：《延安大学》2015年硕士论文

【摘要】：【背景】腓骨远端骨折是常常牵涉关节内的骨折,在临床中治疗中为了尽量减低患者的创伤性或退行性关节炎出现的几率,则在治疗方面常常需要使骨折达到良好的解剖复位。术中是否可以达到解剖复位就成为了手术成功的必要前提及条件。目前对于腓骨远端骨折的手术治疗,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,虽然术后会出现一定的并发症,但可在直视下复位,可使骨折尽量达到理想的复位效果。但是,随着骨折固定理念的变化,髓内固定作为腓骨远端骨折的另一种方法,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】比较髓内钉与钢板治疗腓骨远端骨折的临床差异【方法】分析2012年6月—2014年7月在延安大学附属医院骨科60例腓骨远端骨折分别采用髓内钉和钢板治疗比较。其中(A组)34人,(B组)26人,涉及患者的性别、年龄或者骨折的类型方面,在统计学研究中均无意义(P0.05)。比较两组的切口长度、出血量、手术时间、骨折愈合时间及踝关节功能评分,并利用SPSS17.0对研究的所有临床资料进行统计学方面的分析并得出结论。【结果】所有的患者都进行了临床随访并且时间至少为6个月。髓内钉组的手术切口长度、手术出血量、手术时间小于钢板组,且有统计学意义(P0.05)。骨折愈合时间方面以及术后6个月的踝关节功能评分,髓内钉组与钢板组无明显差别(P0.05)。【结论】对于大多数的腓骨远端骨折,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,临床操作并不复杂。髓内钉为闭合复位,操作技术要求较高,且术中透视次数较多,骨折的复位较钢板略差。但髓内钉组为闭合复位,轴心固定,更符合生物力学,皮肤切口小,软组织剥离自然少,术中出血也较少,骨折断端处的血运得到保护。但是由于腓骨远端本身软组织覆盖少,血运较差,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。
[Abstract]:[background] Distal fibula fractures are often associated with intra-articular fractures. In order to minimize the incidence of traumatic or degenerative arthritis in clinical treatment, it is often necessary to achieve good anatomical reduction in the treatment of distal fibula fractures. Whether or not anatomical reduction can be achieved during the operation becomes the necessary prerequisite and condition for the success of the operation. At present, open reduction combined with plate internal fixation is a common treatment for distal fibula fractures. The technical requirements for doctors are not high in the operation. Although there will be certain complications after operation, they can be reduced under direct vision. Can make fracture as far as possible to achieve ideal reduction effect. However, as the concept of fracture fixation changes, intramedullary fixation as another method of distal fibula fracture requires a relatively small incision and a lower incidence of postoperative complications. But the technical requirements for doctors are high. [objective] to compare the clinical differences between intramedullary nail and plate in the treatment of distal fibula fracture [methods] 60 cases of orthopedics in the affiliated Hospital of Yan'an University from June 2012 to July 2014 were analyzed. The distal fibula fractures were treated with intramedullary nail and plate respectively. Among them, 34 patients in group A and 26 patients in group B were involved in sex, age or type of fracture, which had no significance in statistical study. The incision length, bleeding volume, operative time, fracture healing time and ankle function score were compared between the two groups. All clinical data of the study were statistically analyzed and concluded using SPSS17.0. [results] all patients were followed up for at least 6 months. In the intramedullary nail group, the length of incision, the amount of operative bleeding and the operative time were smaller than those in the plate group, and there was significant difference between the two groups (P 0.05). There was no significant difference between the intramedullary nail group and the plate group in the healing time of fracture and the ankle function score 6 months after operation. [conclusion] for most distal fibula fractures, open reduction and plate fixation is still the routine fixation method. The indications are wide, the distal fibula fracture can achieve anatomical reduction, reliable fixation, good functional recovery, and the clinical operation is not complicated. The intramedullary nail is closed reduction, the operation technique is high, and the times of intraoperative fluoroscopy are more, the reduction of fracture is a little worse than that of steel plate. However, the intramedullary nail group is closed reduction, axial fixation, more in line with biomechanics, skin incision small, soft tissue stripping natural less, less intraoperative bleeding, fracture at the end of the blood was protected. However, due to less soft tissue coverage and poor blood circulation, there was no significant difference in the healing time and the long-term recovery of ankle function between the two groups.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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