内固定与外固定治疗胫骨远端骨折的临床疗效

发布时间：2018-07-20 19:15

【摘要】：目的：通过对胫骨远端骨折患者分别采用切开复位内固定术或外固定架术的治疗患者,比较两种手术方式在临床的适应症和疗效。方法：回顾性分析2012年1月份至2014年3月份经新疆医科大学第一附属医院骨科中心通过手术治疗胫骨远端骨折病例176例,有完整定期随访记录53例,年龄≥50岁,并将分别分成切开复位内固定组以及外固定架组,切开复位内固定组31例(男性：17例,女性：14例)；外固定架组：22例(男性：14例,女性：8例),术后比较两组的手术时间、骨折愈合时间、踝关节功能恢复时间、术后发生感染并发症,参照AOFAS (American Orthopaedic Foot and Ankle Society)评分标准评价踝关节功能及术AOFAS后的优良率。结果：采用spssl7.0统计学分析处理术后定期随访将所符合纳入标准条件的53例病历。(1)内固定组与外固定组在手术时间比较,两组数据通过t检验,t=11.282,P值=0.0001,两组差异有统计学意义：骨折临床愈合时间两组数据通过t检验,t=2.524,P值=0.015,两组差异有统计学意义；恢复工作岗位时间(周)两组数据通过t检验,t=-3.756,P值=0.0001,两组差异有统计学意义。外固定架组较内固定组手术操作时间少,骨折临床愈合时间短；内固定组比外固定架组恢复工作时间较快。(2)两组在术后感染并发症上通过连续性校正后,即校正的χ2=0.785,P值=0.376,两组数据无明显统计学差异；两组在术后AOFAS评分上数据通过t检验,t=1.136,P值=0.261,两组数据无明显统计学差异；以及在两组患者术后优良率方面比较,数据通过卡方检验,χ20.0001,P值=1.000,两组患者术后优良率无明显统计学差异。结论：临床回顾性分析得出,在对于治疗胫骨远端骨折程度较为严重的患者以及对于涉及踝关节面的干骺端作为外固定架可更为安全有效,但切开复位内固定对治疗低能量创伤造成的骨折可作为优先治疗方案。
[Abstract]:Objective: to compare the clinical indications and effects of open reduction and internal fixation or external fixation in patients with distal tibial fractures. Methods: from January 2012 to March 2014, 176 cases of distal tibial fractures were treated by the Orthopaedic Center of the first affiliated Hospital of Xinjiang Medical University. They were divided into open reduction and internal fixation group and external fixator group respectively. There were 31 cases (male: 17, female: 14) in open reduction and internal fixation group, 22 cases (male: 14) in external fixator group. The operative time, fracture healing time, ankle function recovery time and postoperative infection complications were compared between the two groups. The ankle function and the excellent and good rate after operation were evaluated according to the American Orthopaedic foot and Ankle Society (AOFAS). There was significant difference between the two groups by t test (t test 11.282 P = 0.0001): the clinical healing time of fracture in two groups passed t test (t test) and the P value of two groups was 0.015, there was significant difference between the two groups. The recovery time (weekly) of the two groups was 0.0001 by t test (P = 0.0001), and the difference between the two groups was statistically significant. The operation time of the external fixation group was less than that of the internal fixation group, and the time of fracture healing was shorter, and the working time of the internal fixation group was faster than that of the external fixator group. (2) after continuous correction of postoperative infection complications, the operation time of the external fixator group was shorter than that of the internal fixation group. That is to say, the corrected 蠂 2 / 0.785P value was 0.376.There was no significant difference between the two groups in terms of postoperative AOFAS score, and there was no significant difference between the two groups in terms of the excellent and good rate of the two groups, and the difference was not significant between the two groups in terms of the score of AOFAS after operation by t-test (t test), the P value of the two groups was 0.261, and there was no significant difference between the two groups in terms of excellent and good rate. The results of chi-square test showed that the P value of 蠂 20.0001 was 1.000. There was no significant difference in the excellent and good rate between the two groups. Conclusion: the clinical retrospective analysis shows that it is more safe and effective to treat the patients with severe distal tibial fracture and the metaphysis of ankle joint as external fixator. But open reduction and internal fixation can be used as the first treatment for fracture caused by low-energy trauma.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
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本文编号：2134496