本文選題：股骨干骨折　切入點(diǎn)：不愈合　出處：《華北理工大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過回顧性分析我院收治并予手術(shù)治療的股骨干骨折患者的臨床病例和隨訪資料,探討影響股骨干骨折愈合的影響因素,以期為臨床治療提供理論指導(dǎo)和試驗(yàn)依據(jù)。方法通過病歷查閱、電話和門診隨訪篩選自2004年1月至2013年12月我院收治并接受手術(shù)治療的股骨干骨折患者,排除雙側(cè)骨折、同側(cè)有既往骨折病史、患有嚴(yán)重的骨代謝疾病、術(shù)前曾長期應(yīng)用糖皮質(zhì)激素類藥物以及隨訪資料不完整的病例。記錄納入病例的年齡、性別、骨折側(cè)別、骨折類型、骨折分型、合并疾病、手術(shù)方式、術(shù)后負(fù)重時(shí)間、骨折愈合情況等指標(biāo)信息。術(shù)后負(fù)重時(shí)間在12周以后的病例定義為延遲負(fù)重。術(shù)后8~12個(gè)月出現(xiàn)斷端骨化、髓腔封閉、假關(guān)節(jié)形成等不愈合現(xiàn)象,需經(jīng)二次手術(shù)治療者定義為不愈合病例,對確定為延遲愈合并經(jīng)二次手術(shù)治療的患者均列入不愈合病例。采用Fisher’s確切概率法分析年齡、性別、骨折側(cè)別、骨折類型、骨折分型、合并疾病、手術(shù)方式、術(shù)后負(fù)重時(shí)間等是否為影響骨折愈合的因素,采用多因素logistic回歸對以上有統(tǒng)計(jì)學(xué)意義的因素進(jìn)行二次分析。以P0.05表示差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果1本組共收集167例股骨干骨折患者,男性145例,女性22例。年齡17-68歲,左側(cè)股骨干骨折98例,右側(cè)股骨干骨折69例。開放性骨折35例,閉合性骨折132例。簡單骨折88例,楔形骨折36例,粉碎性骨折43例。髓內(nèi)釘固定132例,釘板系統(tǒng)固定35例。2骨折愈合情況:在所有成功隨訪的167病例中,156例患者達(dá)到骨折一期愈合,11例發(fā)生骨折不愈合,愈合率93.4%,骨折不愈合發(fā)生率6.6%。3影響骨折愈合的單因素分析:經(jīng)卡方檢驗(yàn)篩選,骨折類型、骨折分型、術(shù)后負(fù)重時(shí)間三個(gè)變量的差異具有統(tǒng)計(jì)學(xué)意義(P0.05),開放性骨折、粉碎性骨折及延遲負(fù)重骨折患者骨折愈合率較低。年齡、性別、骨折側(cè)、復(fù)合傷、合并疾病、內(nèi)固定方式等因素統(tǒng)計(jì)結(jié)果無統(tǒng)計(jì)學(xué)意義。4各因素影響骨折愈合的后退逐步logistics回歸分析:骨折類型(開放性骨折)、延遲負(fù)重對骨折愈合的影響具有統(tǒng)計(jì)學(xué)意義(P0.05)。在校正了其他因素以后,開放性骨折病例發(fā)生不愈合的風(fēng)險(xiǎn)是閉合性骨折病例的3.853倍;延遲負(fù)重病例發(fā)生不愈合的風(fēng)險(xiǎn)是早期負(fù)重病例的4.127倍。粉碎性骨折對骨折愈合的影響無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論開放性骨折及延遲負(fù)重是股骨干骨折愈合的不利因素,而粉碎性骨折是否為股骨干骨折愈合的不利因素尚有待進(jìn)一步研究證實(shí)。
[Abstract]:Objective to analyze retrospectively the clinical cases and follow-up data of patients with femoral shaft fracture treated in our hospital, and to explore the influencing factors of femoral shaft fracture healing. Methods patients with femoral shaft fractures treated from January 2004 to December 2013 were selected by telephone and outpatient follow-up, and bilateral fractures were excluded, so as to provide theoretical guidance and experimental basis for clinical treatment. Patients with ipsilateral history of fracture, severe bone metabolism, long term preoperative use of glucocorticoids and incomplete follow-up data were recorded, including age, sex, fracture side, fracture type, fracture type, and type of fracture. Complicated diseases, operative methods, weight bearing time after operation, fracture healing, etc. The cases after 12 weeks of postoperative weight loading were defined as delayed load. 8 ~ 12 months after operation, the ossification of the broken end appeared, and the medullary cavity was closed. Nonunion, such as pseudoarthrosis, was defined as a case of nonunion by secondary surgical treatment. All patients who were identified as delayed union and treated by secondary surgery were included as cases of nonunion. Age and sex were analyzed by Fisher's exact probability method. Whether the fracture side, fracture type, fracture type, complicated disease, operation mode, weight bearing time after operation are the factors affecting fracture healing, Multivariate logistic regression was used to analyze the above factors. The difference was statistically significant with P0.05. Results 1 A total of 167cases of femoral shaft fractures were collected, including 145 males and 22 females, aged 17-68 years. There were 98 cases of left femoral shaft fracture, 69 cases of right femoral shaft fracture, 35 cases of open fracture, 132 cases of closed fracture, 88 cases of simple fracture, 36 cases of wedge-shaped fracture, 43 cases of comminuted fracture, 132 cases of intramedullary nail fixation. Nail plate system fixed the healing of fracture in 35 cases of .2 cases. Among 167 cases of successful follow-up, 156 cases had achieved primary healing of fracture and 11 cases had nonunion. The rate of healing was 93.4, the incidence of nonunion was 6.6.3 the univariate analysis of the influence of fracture healing: through chi-square test screening, fracture type, fracture type, weight bearing time after operation, the differences were statistically significant (P 0.05), open fracture. The fracture healing rate of comminuted fracture and delayed weight-bearing fracture was lower. Age, sex, fracture side, compound injury, complicated disease, Regression analysis of regression stepwise logistics regression analysis of factors affecting fracture healing: open fracture type (open fracture, delayed weight loading) had significant effect on fracture healing (P 0.05). After adjusting for other factors, The risk of nonunion in open fractures was 3.853 times higher than that in closed fractures. The risk of nonunion in delayed weight-bearing cases was 4.127 times higher than that in early weight-bearing cases. The effect of comminuted fractures on fracture healing was not statistically significant (P 0.05). Conclusion Open fracture and delayed weight loading are unfavorable factors for fracture healing of femoral shaft. Whether comminuted fracture is the unfavorable factor of femoral shaft fracture healing needs further study.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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本文編號：1623943