本文關鍵詞： 脛骨近端骨折 髓內(nèi)釘 內(nèi)固定　出處：《大連醫(yī)科大學》2015年碩士論文　論文類型：學位論文

【摘要】：目的:比較傳統(tǒng)髕下入路髓內(nèi)釘與新型META-NAIL髕上入路髓內(nèi)釘在治療脛骨近端骨折中的骨折復位精確度、膝關節(jié)功能的優(yōu)良率以及骨折愈合時間等方面療效的比較。方法收集2012年1月~2013年11月至我院就診的46例脛骨近端骨折病例,按治療方法分為傳統(tǒng)髕下入路髓內(nèi)釘治療組(對照組)23例和新型META-NAIL髕上入路髓內(nèi)釘治療組(實驗組)23例,對比分析兩組患者手術時間、住院時間、骨折臨床愈合時間和骨性愈合時間以及通過CT影像比較術后兩組患者脛骨骨折處的冠狀位及矢狀位的軸線成角、移位及肢體短縮情況等臨床相關數(shù)據(jù)。所有患者全部行閉合復位,閉合性骨折的患者術后抗生素使用24h,開放性骨折經(jīng)清創(chuàng)后,應用抗生素3~5天,適量應用脫水藥物,待腫脹消退后行手術治療。張力性水泡的患者,給予脫水藥物靜滴配合浸潤硫酸鎂溶液的紗布覆蓋小腿,待水泡消退后再行手術治療�；颊邇�(nèi)固定術后使用抗生素使用不超過72h,術后2d即應用CPM機輔助訓練,有利于早期恢復膝關節(jié)功能,同時可預防下肢靜脈血栓。結(jié)果全部46例均獲隨訪,平均隨訪時間14±3.5個月(11~18個月),切口均一期愈合�；颊咝g后均行CT檢查,通過測量后提示兩組患者術后冠狀位成角(對照組3.6°±2.8°、實驗組3.8°±2.4°)、矢狀位移位(對照組1.0±3.4mm、實驗組1.2±4.5mm)及冠狀位移位(對照組1.3±5.6mm、實驗組1.1±3.9mm)無顯著性差異(P0.05)。實驗組矢狀位成角(對照組4.9°±3.3°、實驗組2.5°±1.6°)、肢體短縮(對照組1.3±5.6mm、實驗組1.1±3.9mm)較對照組小(P0.05)。兩組手術時間、住院時間、骨折愈合時間兩組未見顯著性差異(P0.05),見表2。按Rasmussen膝關節(jié)功能評分標準評定臨床效果,包括疼痛、行走能力、伸膝、關節(jié)活動度和穩(wěn)定性等5項內(nèi)容,各6分,優(yōu)≥27分,良20~26分,可10~19分,差6~9分。實驗組優(yōu)良率為91.3%與對照組78.3%相比差異有顯著性差異(P0.05)。統(tǒng)計學處理采用SPSS12.0軟件,計數(shù)資料以率表示,組間比較進行X2檢驗,計量資料以均數(shù)±標準差(x±s)表示,組間比較進行t檢驗。P0.05為差異,有統(tǒng)計學意義。結(jié)論在本研究中,我們比較了傳統(tǒng)髓內(nèi)釘和髕上入路髓內(nèi)釘治療脛骨近端骨折的臨床數(shù)據(jù),結(jié)果顯示:兩組患者術后冠狀位成角、矢狀位移位及冠狀位移位無明顯差異(P0.05),實驗組矢狀位成角及肢體短縮較對照組小,差異有統(tǒng)計學意義(P0.05),這恰恰證實了髕上入路髓內(nèi)釘?shù)膬?yōu)勢,即其對骨折前方成角的牽引力很小,理論上將導致預后效果更佳;兩組手術時間、住院時間無顯著差異,實驗組骨折愈合時間明顯較對照組短,差異顯著(P0.05),說明在實際應用中,兩者都能夠獲得滿意的骨折愈合效果;實驗組膝關節(jié)功能評價優(yōu)良率為91.3%,明顯高于對照組的78.3%,差異有統(tǒng)計學意義(P0.05),由于Rasmussen膝關節(jié)功能評分標準包括疼痛、行走能力、伸膝、關節(jié)活動度和穩(wěn)定性等5項內(nèi)容,是一種較全面的來自患者主訴的功能評分,實驗組髕上入路髓內(nèi)釘由于其設計的獨特性,隨訪中髕前痛等并發(fā)癥少,患者依從性和耐受性好,滿意度較高,可能是由于兩組未出現(xiàn)深部感染、下肢深靜脈血栓、內(nèi)固定失效等并發(fā)癥但實驗組仍評分較高的原因。由此可見,髕上入路髓內(nèi)釘較傳統(tǒng)髓內(nèi)釘是存在一定優(yōu)勢的。本研究中的矢狀位成角及肢體短縮的數(shù)據(jù)在兩組間存在顯著性差異但卻并未影響到后續(xù)觀察的骨折愈合結(jié)果(即兩組都獲得了滿意的骨愈合結(jié)局),但若在后續(xù)研究中進一步擴大樣本量并延長隨訪時間,這種影響是否依然存在(即矢狀位成角及肢體短縮的差異導致骨愈合的差異),尚需要進一步觀察。從臨床角度來講,盡可能地獲得滿意的復位和恢復病骨初始角度依然是醫(yī)師們手術操作的期望。綜上所述,對于治療脛骨近端骨折,髕上入路髓內(nèi)釘作為一種較新的髓內(nèi)固定器械,療效滿意,值得推廣。
[Abstract]:Objective: To compare the traditional approach of infrapatellar intramedullary nail and new META-NAIL patellar approach intramedullary nail in the treatment of proximal tibial fractures in fracture reduction accuracy, excellent rate of knee joint function and fracture healing time and curative effect. Methods 46 cases of tibial ~2013 collected from January 2012 November to our hospital in fracture cases, according to the treatment methods are divided into the traditional approach of infrapatellar intramedullary nail treatment group (control group) and 23 cases of the new META-NAIL suprapatellar intramedullary nail way into treatment group (experimental group) 23 cases, analysis of hospitalization time of two groups of patients with operation time, contrast, fracture healing time and bone healing time and the CT images were compared two groups of patients after tibial fracture at the coronal and sagittal axis angle, displacement and limb shortening and other clinical data. All patients underwent closed reduction, closed fracture patients with postoperative antibiotics The use of 24h, open fractures after debridement, antibiotic 3~5 days, the amount of application of dehydration drugs until the swelling subsided after surgery. Blisters were treated with dehydration drugs intravenously with infiltration of Magnesium Sulfate solution gauze to cover the calf, until the blisters subsided after surgery. Patients after internal fixation with antibiotics use no more than 72h, 2D after application of CPM assisted training is conducive to the early recovery of knee joint function, and can prevent venous thrombosis. Results all 46 cases were followed up, the mean follow-up time was 14 + 3.5 months (11~18 months), incision healed. The patients were examined by CT after that, through the measurement of two groups of patients with postoperative coronal angle (control group 3.6 degrees plus or minus 2.8 degrees, the experimental group 3.8 degrees - 2.4 degrees), sagittal displacement (control group experimental group 1 + 3.4mm, 1.2 + 4.5mm) and coronal shift (control group 1.3 + 5.6mm, experimental group 1.1. 3.9mm)鏃犳樉钁楁，

本文編號：1507581