两种手术方式治疗成人胫骨中下段骨折的疗效分析

发布时间：2018-07-18 13:20

【摘要】：目的:探讨使用经皮微创锁定钢板和交锁髓内钉治疗成人胫骨中下段骨折的疗效及其优缺点。方法:2012年12月—2014年05月,对我院收治的胫骨中下段骨折成人患者,共有41例,根据手术方法将其分为经皮微创锁定板固定治疗组和交锁髓内钉固定治疗组。其中男性27例,女性14例。年龄18~70岁,平均40.66±13.72岁。骨折按AO分型,A型12例,B型19例,C型10例。经皮微创锁定板治疗组21例,交锁髓内钉治疗组20例。观察两个治疗组中的患者术中手术治疗胫骨中下段所用的时间及出血量。患者治疗出院后第1、3、6、9、12月门诊随访或电话随访,拍摄患者胫腓骨中下段正侧位X线片,术后9个月根据Johner-Wruhs疗效评分标准评价疗效。结果:41例患者均获得随访及评估。经皮微创锁定板固定治疗组手术时间51~95min,平均为68.90±11.85min,术中出血量75~142ml,平均为99.67±16.01ml;交锁髓内钉固定治疗组手术时间64~120min,平均为85.15±14.93min,术中出血量81~175ml,平均为112.40±23.21ml。术后12个月根据Johner-Wruhs疗效评分标准评价:经皮微创锁定板固定治疗组疗效9例为优、8例为良、3例为可、1例为差;交锁髓内钉固定治疗组疗效10例为优、8例为良、1例为可、1例为差。结论:两治疗组均获得了满意疗效。经皮微创锁定板治疗组在手术时间及术中出血量都较交锁髓内钉治疗组少。两治疗组术后近期疗效无明显差异(P=0.6630.05)无统计学意义。
[Abstract]:Objective: to evaluate the efficacy and advantages of percutaneous minimally invasive locking plate and interlocking intramedullary nail in the treatment of adult middle and lower tibial fractures. Methods: from December 2012 to May 2014, 41 adult patients with middle and lower tibial fractures were treated in our hospital. According to the surgical methods, they were divided into two groups: percutaneous minimally invasive locking plate fixation group and interlocking intramedullary nail fixation group. There were 27 males and 14 females. The age was 1870 years (mean 40.66 卤13.72 years). According to AO classification, there were 12 cases of type A and 19 cases of type B, 10 cases of type C. 21 cases were treated with percutaneous minimally invasive locking plate and 20 cases with interlocking intramedullary nail. To observe the time and amount of blood loss in the operation of the middle and lower tibia in the two treatment groups. The patients were followed up for 12 months by outpatient or telephone. X-ray films of the middle and lower tibia and fibula were taken. The curative effect was evaluated according to Johner-Wruhs score 9 months after operation. Results 41 patients were followed up and evaluated. The mean operative time was 68.90 卤11.85 min in the percutaneous minimally invasive locking plate fixation group, and the average intraoperative bleeding volume was 99.67 卤16.01 ml, and that in the intramedullary nail fixation group was 640.120 min (85.15 卤14.93 min). The intraoperative blood loss was 81175ml (mean 112.40 卤23.21ml) in the interlocking intramedullary nail fixation group. 12 months after operation, according to Johner-Wruhs score, the therapeutic effect of percutaneous minimally invasive locking plate fixation group was excellent in 9 cases, good in 8 cases, good in 3 cases, and poor in 1 case, while in the interlocking intramedullary nail group, the curative effect was excellent in 8 cases, good in 1 case, and poor in 1 case. Conclusion: satisfactory curative effect was obtained in both groups. The time of operation and the amount of intraoperative bleeding in the percutaneous minimally invasive locking plate group were less than those in the interlocking intramedullary nail group. There was no significant difference in the short-term effect between the two groups (P < 0. 6630.05).
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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