辅助钢板与单纯髓内钉固定治疗下肢长骨干AO-C型骨折的对比

发布时间：2019-02-25 08:06

【摘要】：目的:比较及分析单纯交锁髓内钉与交锁髓内钉附加辅助钢板两种固定方式治疗长骨干AO-C型骨折的临床疗效,探讨两种固定方式存在的争议问题,为治疗此类骨折提供一种更好的手术方式及一定的临床依据。方法:采用回顾性分析。收集合肥市第一人民集团医院创伤骨科2011年3月至2016年3月收治的下肢长骨干AO-C型骨折患者的临床资料。根据所使用手术方式不同,将单纯交锁髓内钉归为A组,将辅助以钢板固定的归为B组。比较两组在手术时间、术中出血量、骨折愈合时间、骨折不愈合率、畸形愈合率、邻近关节功能恢复及疗效优良率等方面的数据。所得数据采用统计软件SPSS17.0进行分析,计量采用资料t检验,计数资料采用卡方检验。结果:本研究共搜集到符合纳入标准和排除标准的患者32例,其中男20例,女12例,年龄24~63岁,平均年龄为43岁;其中车祸伤21例,坠落伤7例,摔伤4例;股骨干骨折13例,胫骨干骨折19例;C1型14例,C2型13例,C3型5例。A组和B组在性别、年龄、受伤部位、AO分型、受伤原因等方面差异无统计学意义(P0.05)。A组的15例患者中手术时间为118.3±24.1min,B组17例患者中手术时间为123.1±20.3min,两者差异无统计学意义(P0.05);A组的15例患者中术中出血量348.7±83.4ml,B组17例患者中术中出血量为367.7±71.0ml,两者差异也无统计学意义(P0.05)。A组骨折平均愈合时间为27.2±8.5W,B组骨折平均愈合时间为20.5±9.3W,两组差异有统计学意义(P0.05)。A组15例患者中出现5例骨折不愈合,行二次手术干预后最终获得愈合;B组17例患者中均达到骨性愈合;两组在术后骨折愈合率上差异具有统计学意义(P0.05)。A组术后最终出现1例畸形愈合,而B组则无畸形愈合的出现,差异无统计学意义(P0.05)。,A组的邻近关节功能评分为87.3±7.5分;B组的邻近关节功能评分为95.3±3.5分。两组在关节功能恢复及疗效优良率方面数据比较有统计学意义(P0.05)。结论:相较于单纯交锁髓内钉固定治疗下肢长骨干AO-C型骨折,结合辅助钢板固定治疗具有较高的骨折愈合率,骨折愈合时间缩短,术后并发症少,术后关节功能恢复好。是值得推广的一种手术方式。
[Abstract]:Objective: to compare and analyze the clinical effect of interlocking intramedullary nail and interlocking intramedullary nail plus auxiliary plate in the treatment of long bone AO-C type fracture. To provide a better surgical method and clinical basis for the treatment of this kind of fracture. Methods: retrospective analysis was used. To collect the clinical data of patients with AO-C type fractures of lower extremities treated in Department of Orthopedic Trauma of the first people's Group Hospital of Hefei from March 2011 to March 2016. According to the different operation methods, the intramedullary nail was divided into group A and group B with auxiliary plate fixation. The data of operation time, intraoperative bleeding volume, fracture healing time, fracture nonunion rate, malunion rate, functional recovery of adjacent joints and the excellent and good rate of curative effect were compared between the two groups. The data were analyzed by statistical software SPSS17.0, measured by data t test and counted by chi-square test. Results: a total of 32 patients, including 20 males and 12 females, with an average age of 43 years, were collected, including 21 cases of traffic accidents, 7 cases of falling injuries and 4 cases of falls. 13 cases of femoral shaft fracture, 19 cases of tibial shaft fracture; There were 14 cases of C1 type, 13 cases of C2 type and 5 cases of C3 type. There was no significant difference between group A and group B in sex, age, location of injury, AO classification, cause of injury and so on (P0.05) in). A group, the operative time was 118.3 卤24.1min. In group B, the operative time was 123.1 卤20.3min, there was no significant difference between the two groups (P0.05). In group A, the amount of intraoperative bleeding was 348.7 卤83.4 ml / L and 17 cases in group B was 367.7 卤71.0 ml, and there was no significant difference between the two groups (P0.05). The average healing time of fracture in). A group was 27.2 卤8.5 W. The average healing time of fracture in group B was 20. 5 卤9. 3W.The difference between the two groups was statistically significant (P0.05) 5 cases of nonunion occurred in group). A (P0.05). In group B, bone healing was achieved in 17 patients. There was a significant difference in the rate of fracture healing between the two groups (P0.05). A group, 1 case of malunion was found after operation, while group B had no malunion, the difference was not statistically significant (P0.05).,). The functional score of adjacent joints in group A was 87.3 卤7.5; The functional score of adjacent joints in group B was 95.3 卤3.5. Two groups in the joint function recovery and the curative effect excellent and good rate aspect data comparison has the statistical significance (P0.05). Conclusion: compared with simple interlocking intramedullary nail fixation in the treatment of long bone AO-C fracture of lower extremity, combined with auxiliary plate fixation has higher fracture healing rate, shorter fracture healing time, fewer postoperative complications and better postoperative joint function recovery. Is worth popularizing one kind of operation method.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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