ETN治疗胫骨远端骨折疗效观察
发布时间：2018-12-10 22:08
【摘要】：目的:本研究通过比较应用专家型胫骨髓内钉(Expert Tibial Nail,ETN)和经皮微创钢板(Minimally invasive percutaneous osteosynthesis,MIPPO)治疗胫骨远端骨折的疗效,对ETN治疗胫骨远端骨折的疗效进行观察分析,为临床治疗胫骨远端骨折提供参考。方法:本文选取了2009年到2013年延安大学附属医院骨科收治的98例胫骨远端骨折的患者进行回顾性分析。其中51例胫骨远端骨折的患者采用了ETN闭合复位内固定术,47例患者采用了小切口经皮微创钢板螺钉内固定术。通过比较两种术式治疗胫骨远端骨折的手术时间、术中出血量、术后负重时间、骨折愈合时间、术后的相关并发症、患者术后恢复情况采用踝关节功能Kofoed评分及Johner-Wruhs的胫骨干骨折最终结果评定,进行疗效对比评价。将以上相关数据进行统计学分析,统计结果以P0.05为差异有显著性。结果:本研究共98例患者,所有的患者都获得了6-18个月随访。98例胫骨远端骨折的患者都获得了骨性愈合。经ETN治疗的胫骨远端骨折的患者手术时间为(93.24±22.53)min、出血量为(154.40±40.30)ml、术中X线透视次数(19.3±5.62)次;而采用MIPPO治疗胫骨远端骨折的患者手术时间为(90.16±17.90)min、出血量为(168.42±38.50)ml、术中X线透视次数为(18.2±4.86)次,这些数据均无统计学差异(P0.05)。术后经ETN治疗的患者患肢完全负重时间为(8.50±1.50)周、骨性愈合时间为(19.2±3.2)周,采用MIPPO治疗胫骨远端骨折的患者完全负重时间为(10.62±1.58)周、骨性愈合时间(24.8±8.9)周,即采用ETN治疗胫骨远端骨折的患者的患肢完全负重时间和骨性愈合时间少于采用MIPPO治疗的患者,二者有统计学差异,即P0.05。对术后采用的踝关节功能评分和胫骨骨干骨折的Johner-Wruhs结果评定方面进行对比分析,ETN组和MIPPO组无统计学差异,即P0.05。结论:ETN是治疗胫骨远端骨折比较理想的内固定材料之一,它具有固定骨折牢靠,软组织损伤小的特点,完全适合于胫骨远端皮肤及软组织条件较差的患者,它通过在距离踝穴较近的距离内安放多枚多方向、多立体层面的锁钉,使骨折远端稳定,保护了骨折断端血运,降低了骨折畸形愈合、延迟愈合及不愈合的发生率,是临床上一种较理想的内固定材料。
[Abstract]:Objective: to compare the therapeutic effects of expert tibial intramedullary nail (Expert Tibial Nail,ETN) and percutaneous minimally invasive plate (Minimally invasive percutaneous osteosynthesis,MIPPO) in the treatment of distal tibial fractures, and to observe and analyze the efficacy of ETN in the treatment of distal tibial fractures. To provide a reference for clinical treatment of distal tibial fractures. Methods: 98 cases of distal tibial fractures treated in Department of Orthopaedics, affiliated Hospital of Yan'an University from 2009 to 2013 were retrospectively analyzed. 51 cases of distal tibial fractures were treated with ETN closed reduction and internal fixation, and 47 cases were treated with small incision percutaneous minimally invasive plate screw fixation. The operative time, intraoperative bleeding, weight loading time, fracture healing time and postoperative complications were compared between the two methods for the treatment of distal tibial fractures. The postoperative recovery was evaluated by Kofoed score of ankle function and final result of tibial shaft fracture by Johner-Wruhs. Statistical analysis of the above related data, the statistical results with P0.05 as the significant difference. Results: 98 patients were followed up for 6 to 18 months. 98 patients with distal tibial fractures received bone healing. The operative time of the patients with distal tibial fractures treated with ETN was (93.24 卤22.53) min, and (154.40 卤40.30) ml,. The times of X-ray fluoroscopy were (19.3 卤5.62) times. The operative time of the patients with distal tibial fractures treated with MIPPO was (90.16 卤17.90) min, bleeding volume was (168.42 卤38.50) ml, the times of X-ray fluoroscopy was (18.2 卤4.86) times, there was no significant difference in these data (P0.05). The total weight loading time of the patients treated with ETN was (8.50 卤1.50) weeks, the time of bone healing was (19.2 卤3.2) weeks, and the time of complete weight loading was (10.62 卤1.58) weeks in the patients with distal tibial fractures treated with MIPPO. The time of bone healing was (24.8 卤8.9) weeks, that is, the time of full weight loading and bone healing in patients with distal tibial fractures treated with ETN was shorter than that in patients treated with MIPPO, and there was a statistical difference between the two groups (P0.05). There was no significant difference between ETN group and MIPPO group in ankle function score and Johner-Wruhs evaluation of tibial shaft fracture (P0.05). Conclusion: ETN is one of the ideal internal fixation materials for distal tibial fractures. It has the characteristics of reliable fixation and small soft tissue injury. It is fully suitable for patients with poor skin and soft tissue conditions of distal tibia. It can make the distal end of the fracture stable, protect the blood flow at the broken end of the fracture, and reduce the incidence of malunion, delayed healing and non-union by placing multiple multi-directional and multi-dimensional locking nails within a relatively close distance from the ankle point, so as to stabilize the distal end of the fracture. It is an ideal internal fixation material in clinic.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
[Abstract]:Objective: to compare the therapeutic effects of expert tibial intramedullary nail (Expert Tibial Nail,ETN) and percutaneous minimally invasive plate (Minimally invasive percutaneous osteosynthesis,MIPPO) in the treatment of distal tibial fractures, and to observe and analyze the efficacy of ETN in the treatment of distal tibial fractures. To provide a reference for clinical treatment of distal tibial fractures. Methods: 98 cases of distal tibial fractures treated in Department of Orthopaedics, affiliated Hospital of Yan'an University from 2009 to 2013 were retrospectively analyzed. 51 cases of distal tibial fractures were treated with ETN closed reduction and internal fixation, and 47 cases were treated with small incision percutaneous minimally invasive plate screw fixation. The operative time, intraoperative bleeding, weight loading time, fracture healing time and postoperative complications were compared between the two methods for the treatment of distal tibial fractures. The postoperative recovery was evaluated by Kofoed score of ankle function and final result of tibial shaft fracture by Johner-Wruhs. Statistical analysis of the above related data, the statistical results with P0.05 as the significant difference. Results: 98 patients were followed up for 6 to 18 months. 98 patients with distal tibial fractures received bone healing. The operative time of the patients with distal tibial fractures treated with ETN was (93.24 卤22.53) min, and (154.40 卤40.30) ml,. The times of X-ray fluoroscopy were (19.3 卤5.62) times. The operative time of the patients with distal tibial fractures treated with MIPPO was (90.16 卤17.90) min, bleeding volume was (168.42 卤38.50) ml, the times of X-ray fluoroscopy was (18.2 卤4.86) times, there was no significant difference in these data (P0.05). The total weight loading time of the patients treated with ETN was (8.50 卤1.50) weeks, the time of bone healing was (19.2 卤3.2) weeks, and the time of complete weight loading was (10.62 卤1.58) weeks in the patients with distal tibial fractures treated with MIPPO. The time of bone healing was (24.8 卤8.9) weeks, that is, the time of full weight loading and bone healing in patients with distal tibial fractures treated with ETN was shorter than that in patients treated with MIPPO, and there was a statistical difference between the two groups (P0.05). There was no significant difference between ETN group and MIPPO group in ankle function score and Johner-Wruhs evaluation of tibial shaft fracture (P0.05). Conclusion: ETN is one of the ideal internal fixation materials for distal tibial fractures. It has the characteristics of reliable fixation and small soft tissue injury. It is fully suitable for patients with poor skin and soft tissue conditions of distal tibia. It can make the distal end of the fracture stable, protect the blood flow at the broken end of the fracture, and reduce the incidence of malunion, delayed healing and non-union by placing multiple multi-directional and multi-dimensional locking nails within a relatively close distance from the ankle point, so as to stabilize the distal end of the fracture. It is an ideal internal fixation material in clinic.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
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