三种手术方式治疗胫骨中下段骨折的临床疗效研究

发布时间：2019-02-26 11:31

【摘要】：目的:探讨三种手术方式治疗胫骨中下段骨折的临床疗效。方法:回顾分析在大连医科大学第二附属医院,2013年6月至2014年9月期间,在创伤骨科符合纳入标准的54例患者中,其中男性29例,女性25例,根据手术不同方式分为三组(A B C组),其中A组手术方式为切开复位动力加压钢板内固定,B组手术方式为闭合复位带交锁螺钉内固定,C组手术方式为闭合复位微创经皮锁定加压钢板内固定,通过比较临床及术后指标及johner-wruhs评分方法,评定三种内固定手术方式治疗胫骨中下段骨折的临床疗效。结果:B组、C组分别与A组对比分析在手术时间、术中出血量、切口大小、愈合时间、感染率临床指标上,具有统计学意义(P0.05),B组与C组在上述指标上,无统计学意义(P0.05)。按Johnner—Wruhs方法评价:A组出现感染2例、断板(钉)1例、关节疼痛2例,优良率80.9%。B组感染1例、断关节疼痛1例,优良率86.6%。C组感染1例、关节疼痛2例,优良率88.8%。上述治疗两组之间在优良率上对比均无统计学意义(P0.05)。结论:三种手术方式治疗胫骨中下段骨折均为有效治疗方案,在适应症选择比较分析,切开复位内固定术选择更为宽泛。闭合复位带交锁螺钉内固定术、闭合复位微创经皮锁定加压钢板内固定术的治疗方案,在生物力学方面比较分析中具有优势。至于选择哪种作为治疗胫骨骨折中下段骨折最佳方案,应通过术者经验、骨折类型、患者状况等多方面因素,制定个体化的治疗方案。
[Abstract]:Objective: to investigate the clinical efficacy of three surgical methods in the treatment of middle and lower tibial fractures. Methods: in the second affiliated Hospital of Dalian Medical University, from June 2013 to September 2014, among the 54 patients who met the criteria of orthopaedic trauma, 29 were male and 25 were female. The patients in group A were treated with open reduction and dynamic compression plate internal fixation, and group B were treated with closed reduction and interlocking screw internal fixation, respectively. According to the different methods of operation, (A B C group was divided into three groups: group A was treated with open reduction and dynamic compression plate internal fixation; Group C was treated with closed reduction and minimally invasive percutaneous locking compression plate internal fixation. By comparing the clinical and postoperative indexes and johner-wruhs score, the clinical efficacy of three kinds of internal fixation for the treatment of middle and lower tibial fractures was evaluated. Results: the time of operation, the amount of bleeding during operation, the size of incision, the time of healing and the infection rate in group B and group C were statistically significant compared with those in group A (P0.05) in), B group and group C, and there was no significant difference between group B and group C in terms of operative time, bleeding volume, incision size and healing time. There was no statistical significance (P0.05). According to Johnner-Wruhs method, infection occurred in group A in 2 cases, broken plate (nail) in 1 case, joint pain in 2 cases, excellent and good rate in 80.9%, infection in group B in 1 case, pain in broken joint in 1 case, excellent and good rate in 86.6%, infection in group C in 1 case. The excellent and good rate was 88.8% in 2 cases of joint pain. There was no significant difference in the excellent and good rate between the two groups (P0.05). Conclusion: all the three surgical methods are effective for the treatment of middle and lower tibial fractures, and the choice of open reduction and internal fixation is wider than that of open reduction and internal fixation. Closed reduction with interlocking screw fixation and minimally invasive percutaneous locking compression plate fixation have advantages in biomechanical analysis. As to which is the best method to treat the middle and lower part of tibial fracture, individualized treatment should be made through many factors, such as the experience of the operator, the type of fracture, the condition of the patient and so on.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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