胫骨骨折髓内钉内固定术后影响胫骨力线的相关因素分析

发布时间：2018-06-23 21:25

  本文选题：胫骨骨折 + 髌上入路　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:研究讨论髓内钉治疗胫骨骨折术后影响胫骨力线的相关因素。方法:回顾性分析2013年1月至2015年12月收治于大连医科大学附属第一医院创伤骨科的确诊为胫骨骨折患者94例,年龄18～87岁,平均(44.73±48.79)岁,其中男75例,女19例,双侧胫骨骨折2例,共计96侧胫骨骨折。其中开放性骨折14例,闭合性骨折82例。依据手术切口分髌上入路治疗组及髌下入路治疗组,腓骨固定与否分为腓骨固定组与非固定组,以远端锁定钉数量分为2枚组,3枚组,依据AO/OTA分型分为A型组、B型组、C型组。统计患者性别、年龄、手术时间、出血量、住院天数、骨折分型、术中是否使用辅助复位工具、髓内钉远端锁定钉数量、腓骨是否固定等,测量术后胫骨冠状位、矢状位力线。结果:各组年龄、住院天数、手术时长、出血量、性别差异无统计学差异(P0.05),组间具有可比性。腓骨固定不固定两组间术后胫骨矢状位力线差异无统计学意义(P0.05),两组间术后胫骨冠状位力线差异有统计学意义(P0.05),腓骨固定组术后胫骨冠状位力线优于腓骨不固定组。远端锁定钉数两组间术后胫骨冠状位力线、术后胫骨矢状位力线差异无统计学意义(P0.05)。髌上组与髌下组两组术后胫骨力线无显著差异,但仅对胫骨干骺端骨折对比时,两组间术后胫骨冠状位力线、矢状位力线差异具有统计学意义(P0.05),髌上组术后胫骨冠状位力线、矢状位力线优于髌下组的。胫骨中段骨折髌上组与髌下组两组间术后胫骨冠状位力线、术后胫骨矢状位力线差异没有统计学意(P0.05)。A型、B型、C型三组通过方差分析,在冠状位上不同分型组间没有统计学差异,但在矢状位上有统计学意思。对三组在矢状位上进行组间比较,仅A组与B组之间有统计学意义(P0.05),A组与C组、B组与C组无统计学意义。结论:胫骨干骺端骨折时,髌上入路在恢复和维持胫骨力线方面优于髌下组。腓骨固定与否在矢状位上虽然没有明显差异,但在冠状位上固定组力线要优于不固定组。所以对于胫腓骨同时骨折时,尤其是骨折线离踝关节平面较近时,应固定腓骨。而对于远端锁定钉数,其与术后胫骨力线关系不大,但远期在维持骨折复位上是否满意还需要更多的探究。分型中,诊断为42-A型的胫骨骨折术后力线相对较好,越复杂的胫骨骨折,其术后胫骨力线不齐发生率相对较高。
[Abstract]:Objective: to study the factors influencing tibial force line after tibial fracture treated by intramedullary nail. Methods: from January 2013 to December 2015, 94 patients with tibial fractures were treated in Department of Trauma and Orthopaedics, first affiliated Hospital of Dalian Medical University, with an average age of (44.73 卤48.79) years (75 males and 19 females). Two cases of bilateral tibial fractures, a total of 96 sides of tibial fractures. There were 14 cases of open fracture and 82 cases of closed fracture. The fibula fixation group was divided into fibula fixation group and non-fixed group according to the operative incision. According to the number of distal locking nails, the fibula fixation group was divided into two groups: group C, group A and group B, according to AO/ OTA classification. Sex, age, operation time, bleeding volume, hospital stay, fracture classification, whether assistant reduction tools were used during operation, the number of distal locking nails of intramedullary nail, fibula fixation and so on were counted. The tibial coronal position and sagittal force line were measured. Results: there was no significant difference in age, hospital stay, operation duration, bleeding volume and sex (P0.05) between the groups. There was no significant difference in tibial sagittal force line between the two groups (P0.05), but there was significant difference between the two groups (P0.05). The tibial coronal force line in fibula fixation group was better than that in fibula unstable group. There was no significant difference in tibial coronal force line and tibial sagittal force line between the two groups (P0.05). There was no significant difference in tibial force line between the supratellar group and the subpatellar group, but only for the tibial metaphyseal fracture, the tibial coronal force line and sagittal force line were significantly different between the two groups (P0.05), and the tibial coronal force line was significantly different between the two groups (P0.05). Sagittal force line was superior to infrapatellar group. The tibial coronal force line and tibial sagittal position force line were not significantly different between the two groups in the middle tibial fracture group and the subpatellar fracture group (P0.05). There was no significant difference in the tibial coronal position between the three groups by ANOVA (P0.05) .There was no significant difference between the three groups in different types of tibial tibia in coronal position. But there is statistical meaning in sagittal position. The sagittal position of the three groups was compared only between group A and group B (P0.05) there was no significant difference between group A and group C (group B and C). Conclusion: the superior patellar approach is superior to the subpatellar group in restoring and maintaining the tibial force line in the fracture of tibial metaphysis. Although there was no significant difference in the sagittal position of fibula fixation, the force line of the fixation group in the coronal position was better than that in the unfixed group. Therefore, fibula should be fixed when the tibia and fibula are fractured at the same time, especially when the fracture line is close to the ankle. However, the number of distal locking nails is not related to the tibial force line after operation, but whether the fracture reduction is satisfactory or not in the long term still needs more exploration. In the classification of tibial fractures diagnosed as 42-A, the postoperative force lines were relatively good, and the more complex tibial fractures, the higher the incidence of postoperative tibial force-line unevenness.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
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本文编号：2058488