本文選題：手法復(fù)位　切入點：脛腓骨骨折　出處：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過探討手法復(fù)位帶鎖髓內(nèi)釘固定與單臂式外固定支架固定治療脛腓骨不穩(wěn)定性骨折的臨床療效,尋求一種療效可靠、適宜推廣的脛腓骨不穩(wěn)定性骨折的治療方法。方法:選取60例符合納入標(biāo)準(zhǔn)的脛腓骨不穩(wěn)定性骨折病例,隨機分為治療組(30例,采用手法復(fù)位帶鎖髓內(nèi)釘固定)和對照組(30例,采用手法復(fù)位外固定支架固定),兩組病例術(shù)后常規(guī)用藥。對兩組的手術(shù)方式的術(shù)中出血量、骨折的愈合時間、術(shù)后感染以及骨折愈合后療效評價方面進(jìn)行比較,并作統(tǒng)計學(xué)處理。結(jié)果:隨訪6～12個月,所有骨折均一期愈合,骨折愈合時間12～26周,平均18.7周。治療組與對照組的手術(shù)時間及術(shù)中出血量的比較,無顯著性差異(P0.05);骨折愈合時間比較,治療組16.06±2.70周,對照組19.06±4.09周,兩組骨折愈合時間有顯著差異(P0.05);骨折術(shù)后感染方面,治療組感染無感染病例,對照組有2例發(fā)生淺表感染,兩組病例均未發(fā)生深部感染。對照組感染率為6.7%,統(tǒng)計分析,兩組的感染率無統(tǒng)計學(xué)意義(P0.05),單就百分比而言,外谷底支架組高于髓內(nèi)釘組,感染病例均行二次清創(chuàng)術(shù),術(shù)后給予敏感抗生素治療,定期傷口更換輔料,創(chuàng)面均愈合。骨折愈合后療效評價方面,兩組都采用Johner-Wruhs評分及Mazur踝關(guān)節(jié)評分系統(tǒng)評估患者骨折愈合。Johner-Wruhs評分治療組的優(yōu)良率為:93.3%,對照組的優(yōu)良率為:96.7%;Mazur踝關(guān)節(jié)評分治療組為優(yōu)良率為:93.3%,對照組優(yōu)良率為:90.0%,兩組Johner-Wruhs評分及Mazur踝關(guān)節(jié)評分比較P0.05,無統(tǒng)計學(xué)意義,兩組骨折愈合后的療效無顯著差異。結(jié)論:手法復(fù)位帶鎖髓內(nèi)釘固定和外固定支架固定都是治療脛腓骨不穩(wěn)定性骨折的有效方法,兩者都有創(chuàng)傷小,愈合率高等優(yōu)點。但帶鎖髓內(nèi)釘治療脛腓骨骨折具有固定牢靠,骨折愈合時間短,感染率低等優(yōu)點。外固定支架雖然操作簡單,創(chuàng)傷小,拆除外固定支架無需二次手術(shù),但釘孔感染的發(fā)生率較高。
[Abstract]:Objective: to explore the clinical effect of manipulative reduction and interlocking intramedullary nail fixation and single arm external fixation in the treatment of unstable tibia and fibula fracture.Methods: sixty cases of unstable fracture of tibia and fibula were randomly divided into treatment group (n = 30) and control group (n = 30).Manual reduction and external fixation were used to fix the stents, and the patients in both groups were treated routinely after operation.The amount of intraoperative bleeding, the time of fracture healing, postoperative infection and the evaluation of curative effect after fracture healing were compared between the two groups, and statistical analysis was made.Results: all the fractures were healed at the first stage for 6 ~ 12 months. The healing time was 1226 weeks (mean 18.7 weeks).There was no significant difference in operative time and intraoperative bleeding between treatment group and control group (P 0.05), fracture healing time was 16.06 鹵2.70 weeks in treatment group and 19.06 鹵4.09 weeks in control group.There were no infection cases in the treatment group, 2 cases in the control group, and no deep infection in both groups.The infection rate in the control group was 6.7. The infection rate in the two groups was not statistically significant (P 0.05). In terms of percentage, the rate of infection in the outer-floor stent group was higher than that in the intramedullary nail group, the infection cases were treated with secondary debridement, and the patients were treated with sensitive antibiotics after operation.The wounds were healed when the excipients were changed regularly.The evaluation of curative effect after fracture healing,Both groups were evaluated by Johner-Wruhs score and Mazur ankle scoring system. Johner-Wruhs score was used to evaluate fracture healing. The excellent and good rate in the treatment group was 10: 93. 3, the excellent and good rate in the control group was 96. 7%. The excellent and good rate in the control group was 9. 93. 3%. The excellent and good rate in the control group was 9. 0. The excellent and good rate in the control group was 9. 90.There was no significant difference between Johner-Wruhs score and Mazur ankle score (P 0.05).There was no significant difference in the effect of fracture healing between the two groups.Conclusion: manipulative reduction and interlocking intramedullary nail fixation and external fixation are effective methods for the treatment of unstable tibia and fibula fractures, both of which have the advantages of small trauma and high healing rate.But the treatment of tibiofibular fracture with interlocking intramedullary nail has the advantages of firm fixation, short healing time and low infection rate.Although the external fixator is simple in operation and less traumatic, it does not require secondary operation to remove the external fixator, but the incidence of nail hole infection is high.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 孫勇;;外固定與內(nèi)固定治療脛骨中下段骨折效果比較[J];河南醫(yī)學(xué)研究;2016年10期

2 馮奕鑫;;多功能外固定架聯(lián)合髓內(nèi)釘內(nèi)固定治療脛腓骨開放性骨折的療效[J];吉林醫(yī)學(xué);2016年08期

3 尚紅濤;王泉;劉斌;;微創(chuàng)經(jīng)皮鋼板接骨術(shù)技術(shù)與開放復(fù)位普通接骨板固定治療高能量脛骨干骨折的療效比較[J];中國老年學(xué)雜志;2016年09期

4 柏松;駱立暉;吳春云;李宗保;;下肢骨折外固定器固定術(shù)后發(fā)生針孔感染的危險因素分析[J];中國骨傷;2016年02期

5 張志仕;;中醫(yī)正骨手法治療腓骨骨折30例[J];河南中醫(yī);2015年06期

6 王展;李妙玉;王晶;;骨外固定支架治療脛腓骨骨折的臨床護(hù)理分析[J];中國醫(yī)藥指南;2015年11期

7 史天林;高占良;宋小龍;;鎖定加壓鋼板外置在脛腓骨骨折治療中的應(yīng)用[J];中國骨與關(guān)節(jié)損傷雜志;2014年S1期

8 周慶華;;MSCT和MRI對脛骨平臺骨折的臨床診斷價值[J];現(xiàn)代儀器與醫(yī)療;2014年03期

9 桑建新;劉世興;張俊杰;宋朝華;;鎖定鋼板外固定治療脛腓骨骨折[J];臨床骨科雜志;2014年02期

10 郁耀平;陳大偉;俞光榮;;Pilon骨折中腓骨固定的研究[J];中國矯形外科雜志;2013年20期

，

本文編號：1691350