逆行髓内钉与锁定钢板治疗股骨远端骨折的疗效比较

发布时间：2018-06-13 05:33

本文选题：股骨远端骨折 + 逆行髓内钉　；参考：《安徽医科大学》2015年硕士论文

【摘要】：目的:通过观察比较分析股骨逆行髓内钉与股骨远端锁定钢板内固定治疗股骨远端骨折的临床疗效,以探讨内固定治疗股骨远端骨折更佳的方法。材料与方法:1.研究对像:本研究为回顾性研究,分析了2007年2月至2014年3月期间收治的54例股骨远端骨折患者,年龄在20~86岁之间(平均54.6岁),其中采用股骨逆行髓内钉内固定手术治疗28例,采用股骨远端锁定钢板内固定手术治疗26例。2.观察指标:a.患者术前一般资料:性别、年龄、骨折类型、致伤原因、伤后至手术等待的时间。b.术中相关资料:手术时间、术中出血量。c.术后随访资料:骨折愈合的时间、膝关节的功能恢复情况的Kolmert评定。3.统计学处理:采用SPSS19.0统计软件,计量资料用x±S表示,采用t检验,计数资料采用X2检验,评价两组之间的疗效比较,P0.05认为差异有统计学意义。结果:54例患者术后获得8~24个月(平均12.8个月)随访,所有病例均获得了骨性愈合。逆行髓内钉组:28例行股骨逆行髓内钉内固定手术治疗,受伤至手术的平均等待时间为5.68±2.67天,平均手术时间为154.64±56.07min,术中平均出血量为388.57±170.77ml。全部获得随访,其中出现膝关节中轻度疼痛1例,无感染、内固定松动等并发症。随访后本组的平均骨折愈合时间为22.54±2.95周。根据Kolmert膝关节功能评定系统进行评定,在本组患者中,优:18例,良:6例,可:4例,差:0例,优良率85.7%。2.锁定钢板组:26例行锁定钢板内固定手术治疗,受伤至手术的平均等待时间为5.42±2.21天,平均手术时间为131.73±72.99min,术中平均出血量为403.85±242.46 ml。全部获得随访,其中出现轻度膝内翻畸形2例,出现深静脉血栓1例,无感染、内固定松动等并发症。随访后本组的平均骨折愈合时间为24.96±3.70周。根据Kolmert膝关节功能评定系统进行评定,在本组患者中,优:16例,良:5例,可:4例,差:1例,优良率80.8%。3.数据统计结果:在逆行髓内钉组和锁定钢板组,在手术时间和术中出血量、膝关节功能优良率方面两组比较,结果无统计学差异(P0.05)。在骨折愈合时间方面,髓内钉组和锁定钢板组分别为22.54±2.95周和24.96±3.70周,两组比较,髓内钉组较锁定钢板组愈合时间短,结果有统计学差异(P0.05)。结论:逆行髓内钉与锁定钢板均是内固定治疗股骨远端骨折的有效方法。相比较而言,逆行髓内钉较锁定钢板内固定治疗股骨远端骨折所需的骨折愈合时间短,更有利于骨折愈合;在膝关节功能的恢复方面,两者均能获得满意的疗效。
[Abstract]:Objective: to compare and compare the clinical effect of retrograde intramedullary nail and locking plate fixation on distal femoral fracture and to explore the better method of internal fixation for distal femoral fracture. Materials and methods: 1. Subjects: this study was a retrospective analysis of 54 patients with distal femur fractures who were treated between February 2007 and March 2014, aged between 20 and 86 years (mean 54.6 years old), 28 of whom were treated with retrograde intramedullary nail fixation. 26 cases were treated by internal fixation with locking plate of distal femur. The observation index is: A. Preoperative general data: sex, age, fracture type, cause of injury, time from injury to operation. Intraoperative data: operation time, intraoperative bleeding volume. Postoperative follow-up data: fracture healing time, knee function recovery of Kolmert rating. 3. Statistical processing: SPSS 19.0 statistical software, measurement data expressed by x 卤S, using t test, count data using X2 test, the evaluation of the two groups of curative effect comparison P0.05 think there is statistical significance. Results 54 cases were followed up for 824 months (mean 12.8 months). In retrograde intramedullary nail group, 28 cases were treated with retrograde femoral intramedullary nail fixation. The average waiting time from injury to operation was 5.68 卤2.67 days, the average operative time was 154.64 卤56.07 min, and the average intraoperative bleeding was 388.57 卤170.77 ml. All cases were followed up, including 1 case of mild knee pain, no infection, loosening of internal fixation and other complications. The average healing time was 22.54 卤2.95 weeks after follow-up. According to Kolmert knee joint function evaluation system, in this group, 18 cases were excellent: 18 cases, 6 cases good: 6 cases, 4 cases: may: 4 cases, 0 cases poor: 0 cases, the excellent and good rate was 85.75.0.2. The average waiting time from injury to operation was 5.42 卤2.21 days, the average operation time was 131.73 卤72.99 minutes, and the average blood loss during operation was 403.85 卤242.46 ml. All cases were followed up, including 2 cases of mild varus genu deformity, 1 case of deep venous thrombosis, no infection, loosening of internal fixation and other complications. The average healing time was 24.96 卤3.70 weeks. According to Kolmert knee joint function evaluation system, 16 cases were excellent in this group, 5 cases were good: 5 cases were good, 4 cases were fair, 1 case was poor. The excellent and good rate was 80.8.3. Results: in the retrograde intramedullary nail group and the locking plate group, there was no significant difference between the two groups in the operation time, intraoperative bleeding volume, and the excellent and good rate of knee joint function. There was no significant difference between the two groups (P 0.05). The healing time of intramedullary nail group and locking plate group were 22.54 卤2.95 weeks and 24.96 卤3.70 weeks, respectively. The healing time of intramedullary nail group was shorter than that of locking plate group (P 0.05). Conclusion: both retrograde intramedullary nail and locking plate are effective methods for the treatment of distal femur fracture. In comparison, retrograde intramedullary nail has shorter healing time than locking plate fixation for distal femur fracture, which is more beneficial to fracture healing. Both of them can obtain satisfactory results in the recovery of knee joint function.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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