胫骨侧交锁髓内钉与锁定钢板治疗浮膝损伤的疗效比较

发布时间：2018-11-09 19:20

【摘要】：目的通过对交锁髓内钉与锁定钢板内固定治疗Fraser I型浮膝损伤胫骨侧骨折的资料进行总结,进一步分析两种不同内固定方法在手术平均时间、术中出血、出现骨痂时间、负重时间、平均愈合时间、术后疗效、术后并发症等方面是否有统计学意义,为Fraser I型浮膝损伤胫骨侧骨折治疗方法的选择提供帮助。方法采用回顾性分析方法,选取河北省创伤骨科中心(唐山市第二医院)2009年1月~2013年12月期间收治45例Fraser I型浮漆损伤患者。所有患者均为闭合性损伤。股骨侧使用交锁髓内钉治疗。根据胫骨侧固定方式不同,将其分成两组,交锁髓内钉组和锁定钢板组。随访12~36个月,平均24.5±1.5个月。交锁髓内钉组23例,其中男性13例,女性10例,年龄18~56岁,平均38.5±2.5岁。左侧12例,右侧11例。受伤原因:交通伤10例,高处坠落伤8例,压砸伤5例;其中合并腹部脏器伤2例,胸部外伤2例;颅脑外伤1例。锁定钢板组22例,男12例,女10例;年龄18~58岁,平均38.5±2.5岁。左侧10例,右侧12例。受伤原因:交通伤11例,高处坠落伤7例,压砸伤4例;其中合并腹部脏器伤3例,胸部外伤1例;颅脑外伤1例。比较两种不同内固定方法在手术平均时间、术中出血、出现骨痂时间、负重时间、平均愈合时间、术后疗效、术后并发症。结果45例患者均获得随访。交锁髓内钉组和锁定钢板组在年龄,性别,左侧与右侧,受伤原因等方面(P0.05)具有可比性没有显著差异。交锁髓内钉组手术平均时间为90.09±9.19min,锁定钢板组手术平均时间为94.73±10.39min,显示两者手术时间及术后并发症方面无显著差异(P0.05)。按Karlstrom和Olerud功能标准评价,交锁髓内钉组:优为18例,良为2例,中为3例,差为0例,优良率为87%;锁定钢板组:优为11例,良为2例,中为7例,差为2例,优良率为59.1%,交锁髓内钉术后优良率较锁定钢板组高。在术中出血量、出现骨痂时间、负重时间、平均愈合时间相比,交锁髓内钉组:分别为248.74±43.23ml、2.16±0.45个月、3.22±0.45个月、11.30±1.94个月。锁定钢板组:分别为322.95±43.39ml、2.94±0.45个月、4.83±0.69个月、13.42±1.66个月。两组相比,交锁髓内钉组均较锁定钢板组短,之间的差异具有统计学意义(P0.05)。结论除手术时间与术后并发症差异无统计学意义,在术中出血量、出现骨痂时间、负重时间、平均愈合时间、术后优良率等方面,交锁髓内钉组都明显优于锁定钢板组。交锁髓内钉组,增大了早期功能锻炼的可能性,骨折愈合得到有效促进,肌肉萎缩和关节僵直等并发症的发生率得到遏制。虽然交锁髓内钉和锁定钢板从力学及生物学角度促使骨折愈合,有其各自的特点与适应症,但是交锁髓内钉具有固定稳定,便于骨折愈合,降低感染率,减少失血量,降低内固定失败率等优势,可作为长骨简单骨干骨折的首选方法。
[Abstract]:Objective to summarize the data of interlocking intramedullary nail and locking plate fixation in the treatment of tibial lateral fracture with Fraser type I floating knee injury, and to analyze the mean operative time, bleeding and callus time of two different internal fixation methods. The weight loading time, average healing time, postoperative curative effect and postoperative complications were statistically significant, which could be helpful for the treatment of tibial side fracture with Fraser type I floating knee injury. Methods by retrospective analysis, 45 patients with Fraser type I floating lacquer injury were selected from the trauma orthopedic center of Hebei Province (Tangshan second Hospital) from January 2009 to December 2013. All patients had closed injury. The femoral side was treated with interlocking intramedullary nail. According to the different way of tibial lateral fixation, they were divided into two groups: interlocking intramedullary nail group and locking plate group. The follow-up was 12 ~ 36 months with an average of 24.5 卤1.5 months. There were 23 cases in the interlocking intramedullary nail group, including 13 males and 10 females, aged 1856 years (mean 38.5 卤2.5 years). Left 12 cases, right 11 cases. There were 10 cases of traffic injury, 8 cases of falling injury and 5 cases of crush injury, including 2 cases of abdominal organ injury, 2 cases of chest injury and 1 case of craniocerebral injury. In the locking plate group, 22 cases were male (12 cases) and female (10 cases), the age was 1858 years (mean 38.5 卤2.5 years). There were 10 cases on the left side and 12 cases on the right side. There were 11 cases of traffic injury, 7 cases of falling injury and 4 cases of crush injury, including 3 cases of abdominal organ injury, 1 case of chest injury and 1 case of craniocerebral injury. The mean operative time, intraoperative bleeding, callus time, weight loading time, average healing time, postoperative efficacy and postoperative complications were compared between the two internal fixation methods. Results all 45 patients were followed up. There was no significant difference in age, sex, left and right side, injury cause and so on between interlocking intramedullary nail group and locking plate group (P0.05). The mean operative time of interlocking intramedullary nail group was 90.09 卤9.19 min, and that of locking plate group was 94.73 卤10.39 min. There was no significant difference in operative time and postoperative complications between the two groups (P0.05). According to Karlstrom and Olerud functional criteria, the results of interlocking intramedullary nail group were excellent in 18 cases, good in 2 cases, moderate in 3 cases, poor in 0 cases, and excellent and good rate was 87%. In locking plate group, 11 cases were excellent, 2 cases were good, 7 cases were moderate, 2 cases were poor, the excellent and good rate was 59.1%. The excellent and good rate of interlocking intramedullary nail was higher than that of locking plate group. The blood loss, callus time, weight loading time and average healing time were 248.74 卤43.23 ml, 2.16 卤0.45 months, 3.22 卤0.45 months and 11.30 卤1.94 months respectively in the interlocking intramedullary nail group. The locking plate group was 322.95 卤43.39 ml / L 2.94 卤0.45 months, 4.83 卤0.69 months and 13.42 卤1.66 months respectively. Compared with the two groups, the interlocking intramedullary nail group was shorter than the locking plate group, the difference was statistically significant (P0.05). Conclusion there was no significant difference between the operative time and postoperative complications. The intramedullary interlocking nail group was superior to the locking plate group in terms of blood loss, callus time, weight loading time, average healing time and postoperative excellent and good rate. In interlocking intramedullary nail group, the possibility of early functional exercise was increased, fracture healing was effectively promoted, and the incidence of complications such as muscular atrophy and joint stiffness was restrained. Although interlocking intramedullary nails and locking plates have their own characteristics and indications for fracture healing in terms of mechanics and biology, interlocking intramedullary nails have stable fixation, facilitate fracture healing, reduce infection rates, and reduce blood loss. Reducing the failure rate of internal fixation can be the first choice for simple long bone fractures.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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