髓内钉髌上入路与经髌韧带入路治疗胫骨骨折临床疗效观察
发布时间：2018-09-04 16:05
【摘要】：目的:对比研究新型META-NAIL胫骨髓内钉髌上入路与经髌韧带入路胫骨髓内钉闭合复位内固定术治疗胫骨骨折的临床疗效。方法:回顾性分析自2014年12月到2016年10月山东省中医院创伤骨科治疗的40例具有完整资料的胫骨骨折的住院患者,随机分为A、B两组,每组20例,A组行新型META-NAIL髌上入路胫骨髓内钉闭合复位内固定术,B组行经髌韧带入路胫骨髓内钉闭合复位内固定术。通过比较两组手术时间、术中透视次数、术中的出血量、骨折愈合率、术后髌前痛并根据Johner-Wuchs评分标准评判两组患者术后功能。结果:所有患者均获得随访,随访时间为9～12个月,平均为10.3个月,随访期间均未发现髓内钉、螺钉断裂。3例患者出现延迟愈合,1例出现畸形愈合,其中A组1例延迟愈合,B组2例,B组患者出现1例畸形愈合。术后12个月随访,A组骨折愈合率100%,B组骨折愈合率95%,A组与B组的骨折愈合率(p=0.4320.05)无统计学意义。A组手术时间:70～180分钟,平均122.2分钟;B组手术时间:90～215分钟,平均158.5分钟,两组手术时间(p=0.020.05)有统计学差异。A组术中出血量:60～150ml,平均86.15ml;B组术中出血量:65～120ml,平均90.5ml,两组术中出血量(p=0.4650.05)无统计学意义。A组术中透视次数:12～30次,平均18.8次;B组术中透视次数:26～50次,平均35.35次。两组术中透视次数(p=0.0010.05)有统计学意义。A组术后髌前痛出现1例,B组5例。两组髌前痛出现率(P=0.0240.05)有统计学意义。Johner-Wuchs评分标准评判两组患者术后功能,78-100分A组:优,16例,良,4例;B组:优12例,良,7例,差,1例。A组优良率100%,B组优良率95%,两组优良率(p=0.4320.05)无统计学意义。结论:对于胫骨骨折的手术治疗,无论采用新型META-NAIL胫骨髓内钉闭合复位内固定术髌上入路还是采用胫骨髓内钉经髌韧带入路均能取得良好疗效;A组比B组术中透视次数少,术后髌前痛率发生小,手术操作时间少,因此,新型META-NAIL胫骨髓内钉髌上入路闭合复位内固定术治疗胫骨骨折,具有手术操作时间少、术中透视次数少,术后髌前痛发生率小的特点,在临床上值得推广使用。
[Abstract]:Objective: to compare the clinical effect of new META-NAIL tibial intramedullary nail supracrapatellar approach and transpatellar ligament approach for tibial fracture treated by closed reduction and internal fixation of tibial intramedullary nail. Methods: from December 2014 to October 2016, 40 patients with tibial fractures treated by Department of Orthopaedics, Shandong Provincial Hospital of traditional Chinese Medicine, were randomly divided into two groups. 20 cases of each group were treated with new META-NAIL supracrapatellar approach and group B with closed reduction and internal fixation of tibial intramedullary nail via patellar ligamentous approach, and group B with closed reduction and internal fixation of tibial intramedullary nail via patellar ligament approach. The time of operation, the times of fluoroscopy, the amount of blood lost during operation, the rate of fracture healing and the postoperative prepatellar pain were compared between the two groups. The postoperative function of the two groups was evaluated according to the Johner-Wuchs score. Results: all the patients were followed up for 9 ~ 12 months with an average of 10.3 months. No intramedullary nail was found during the follow-up. One patient in group A had delayed healing and 2 patients in group B had malunion. 12 months after operation, the fracture healing rate of group A was 100 and that of group B was 95. There was no significant difference between group A and group B. the operative time of group A was 122.2 minutes, and the average time of operation in group B was 158.5 minutes. There was significant difference in the operative time between the two groups (p0. 020.05). There was no significant difference in the intraoperative blood loss between the two groups (p0. 0. 020.05). The intraoperative blood loss of group A was 1: 60150 ml, with an average of 86. 15 ml. The average intraoperative blood loss of group B was 0. 65120 ml, with an average of 9. 5 ml. There was no significant difference in the amount of intraoperative bleeding between the two groups (p0. 4650.05). The average number of fluoroscopy in group B was 18.8 times, 2650 times (average 35.35 times). The times of fluoroscopy in both groups (p < 0.0010.05) were statistically significant. Group A had 1 case of prepatellar pain after operation and group B (5 cases). The incidence rate of prepatellar pain (P0. 024. 05) in two groups was statistically significant. Johner-Wuchs score was 78-100 points in group A: 16 cases were excellent, 4 cases were good, 12 cases were excellent, 7 cases were good. The excellent and good rate of group A was 100%. The excellent and good rate of group B was 950.The excellent and good rate of two groups (p0. 4320.05) had no statistical significance. Conclusion: for the treatment of tibial fractures, both new META-NAIL tibial intramedullary nail closed reduction and internal fixation and tibial intramedullary nail transpatellar approach can achieve good results. Group A has fewer times of fluoroscopy than group B. The incidence of prepatellar pain was small, and the operative time was less. Therefore, the new META-NAIL tibial intramedullary nailing closed reduction and internal fixation with suprapatellar nailing for tibial fracture had less operative time and less fluoroscopy during operation. The incidence of prepatellar pain is small, which is worth popularizing in clinic.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
本文编号：2222666
[Abstract]:Objective: to compare the clinical effect of new META-NAIL tibial intramedullary nail supracrapatellar approach and transpatellar ligament approach for tibial fracture treated by closed reduction and internal fixation of tibial intramedullary nail. Methods: from December 2014 to October 2016, 40 patients with tibial fractures treated by Department of Orthopaedics, Shandong Provincial Hospital of traditional Chinese Medicine, were randomly divided into two groups. 20 cases of each group were treated with new META-NAIL supracrapatellar approach and group B with closed reduction and internal fixation of tibial intramedullary nail via patellar ligamentous approach, and group B with closed reduction and internal fixation of tibial intramedullary nail via patellar ligament approach. The time of operation, the times of fluoroscopy, the amount of blood lost during operation, the rate of fracture healing and the postoperative prepatellar pain were compared between the two groups. The postoperative function of the two groups was evaluated according to the Johner-Wuchs score. Results: all the patients were followed up for 9 ~ 12 months with an average of 10.3 months. No intramedullary nail was found during the follow-up. One patient in group A had delayed healing and 2 patients in group B had malunion. 12 months after operation, the fracture healing rate of group A was 100 and that of group B was 95. There was no significant difference between group A and group B. the operative time of group A was 122.2 minutes, and the average time of operation in group B was 158.5 minutes. There was significant difference in the operative time between the two groups (p0. 020.05). There was no significant difference in the intraoperative blood loss between the two groups (p0. 0. 020.05). The intraoperative blood loss of group A was 1: 60150 ml, with an average of 86. 15 ml. The average intraoperative blood loss of group B was 0. 65120 ml, with an average of 9. 5 ml. There was no significant difference in the amount of intraoperative bleeding between the two groups (p0. 4650.05). The average number of fluoroscopy in group B was 18.8 times, 2650 times (average 35.35 times). The times of fluoroscopy in both groups (p < 0.0010.05) were statistically significant. Group A had 1 case of prepatellar pain after operation and group B (5 cases). The incidence rate of prepatellar pain (P0. 024. 05) in two groups was statistically significant. Johner-Wuchs score was 78-100 points in group A: 16 cases were excellent, 4 cases were good, 12 cases were excellent, 7 cases were good. The excellent and good rate of group A was 100%. The excellent and good rate of group B was 950.The excellent and good rate of two groups (p0. 4320.05) had no statistical significance. Conclusion: for the treatment of tibial fractures, both new META-NAIL tibial intramedullary nail closed reduction and internal fixation and tibial intramedullary nail transpatellar approach can achieve good results. Group A has fewer times of fluoroscopy than group B. The incidence of prepatellar pain was small, and the operative time was less. Therefore, the new META-NAIL tibial intramedullary nailing closed reduction and internal fixation with suprapatellar nailing for tibial fracture had less operative time and less fluoroscopy during operation. The incidence of prepatellar pain is small, which is worth popularizing in clinic.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
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