本文選題：鎖骨　切入點(diǎn)：骨折　出處：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的對(duì)比螺紋彈性髓內(nèi)釘(Threaded Elastic Intramedullary Nail,TEIN)和重建鋼板治療鎖骨中段骨折(Displaced Midshaft Clavicle Fracture,DMCF)的臨床應(yīng)用效果。方法回顧性分析2010年1月至2013年1月間于天津醫(yī)科大學(xué)第四中心臨床學(xué)院骨一科收治的77例鎖骨骨折病人。接受螺紋彈性髓內(nèi)釘內(nèi)固定治療的為實(shí)驗(yàn)組,45例;接受重建鋼板內(nèi)固定治療的為對(duì)照組,32例。收集患者臨床資料:性別、年齡、患側(cè)、骨折分型、治療方式、手術(shù)時(shí)間、隨訪期限、并發(fā)癥情況、內(nèi)置物取出時(shí)間、肩關(guān)節(jié)DASH評(píng)分和Constant評(píng)分。對(duì)收集的資料進(jìn)行正態(tài)性檢驗(yàn),如果計(jì)量資料符合正態(tài)分布,或近似于正態(tài)分布,可以使用Student’s T檢驗(yàn)方法,以均值±標(biāo)準(zhǔn)差的形式記錄。如果計(jì)量資料不符合正態(tài)分布,則使用秩和檢驗(yàn)分析,以中位數(shù)(四分位數(shù)間距)的形式記錄。計(jì)數(shù)資料使用絕對(duì)值(百分比)的形式記錄,使用c2卡方檢驗(yàn)和Fisher確切概率法分析。使用SPSS軟件(17.0,美國(guó))進(jìn)行數(shù)據(jù)的統(tǒng)計(jì)學(xué)處理,檢驗(yàn)水準(zhǔn)均取雙側(cè)a=0.05。結(jié)果1.鋼板組患者平均年齡42.2歲(28-61歲),髓內(nèi)釘組患者平均年齡39.4歲(18-65歲),兩組患者年齡均符合正態(tài)分布,兩組差異沒(méi)有統(tǒng)計(jì)學(xué)意義。2.受傷的機(jī)制主要有:摔倒、運(yùn)動(dòng)損傷、車(chē)禍、自行車(chē)跌落,兩組患者各種骨折發(fā)生機(jī)制的發(fā)生率差異沒(méi)有統(tǒng)計(jì)學(xué)意義。3.采用OTA骨折分型,兩組患者間A型、B型骨折占比之間的差異沒(méi)有統(tǒng)計(jì)學(xué)意義。4.兩組患者手術(shù)時(shí)間符合正態(tài)分布,髓內(nèi)釘組比鋼板組的手術(shù)時(shí)間短(36.93±8.32分VS 56.91±7.77分),組間差異有統(tǒng)計(jì)學(xué)意義;兩組患者X線暴露時(shí)間符合正態(tài)分布,髓內(nèi)釘組X線暴露時(shí)間比鋼板組久(8.32±1.93秒VS6.70±1.17秒),組間差異有統(tǒng)計(jì)學(xué)意義;兩組患者失血量使用秩和檢驗(yàn),髓內(nèi)釘組出血量比鋼板組少(25.00 ml VS 122.50 ml),差異有統(tǒng)計(jì)學(xué)意義;兩組患者骨愈合時(shí)間使用秩和檢驗(yàn),髓內(nèi)釘組骨愈合時(shí)間比鋼板組短(12.00周VS13.50周),差異有統(tǒng)計(jì)學(xué)意義。5.鋼板組與髓內(nèi)釘組術(shù)后各種并發(fā)癥的發(fā)生率組間差異沒(méi)有統(tǒng)計(jì)學(xué)意義。髓內(nèi)釘組肩關(guān)節(jié)Constant評(píng)分在術(shù)后1個(gè)月、3個(gè)月、6個(gè)月時(shí),比鋼板組肩關(guān)節(jié)Constant評(píng)分優(yōu)秀,組間差異有統(tǒng)計(jì)學(xué)意義。髓內(nèi)釘組肩關(guān)節(jié)DASH評(píng)分在術(shù)后1個(gè)月、3個(gè)月、6個(gè)月時(shí),比鋼板組肩關(guān)節(jié)DASH評(píng)分更佳,組間差異有統(tǒng)計(jì)學(xué)意義。術(shù)后12個(gè)月時(shí),兩組間DASH評(píng)分和Constant評(píng)分差異均沒(méi)有統(tǒng)計(jì)學(xué)意義。髓內(nèi)釘組所有患者均于術(shù)后取出內(nèi)固定物,而鋼板組有18例(56%)患者取出了內(nèi)固定物。結(jié)論螺紋彈性髓內(nèi)釘?shù)奈?chuàng)術(shù)式與鋼板內(nèi)固定術(shù)相比,操作簡(jiǎn)便、創(chuàng)傷小、理想復(fù)位、可靠固定、早期恢復(fù)功能、縮短愈合時(shí)間、減少術(shù)后并發(fā)癥、避免二次住院手術(shù),減少患者身心及經(jīng)濟(jì)負(fù)擔(dān),手術(shù)難度不大,適于基層醫(yī)院推廣使用。
[Abstract]:Objective to compare the clinical effects of threaded Elastic Intramedullary Nailtein and reconstruction plate in the treatment of displaced Midshaft Clavicle FractureMMC.Methods from January 2010 to January 2013, 77 patients with clavicle fracture were retrospectively analyzed.45 cases of experimental group were treated with screw elastic intramedullary nail and 32 cases of control group were treated with internal fixation of reconstructed plate.The clinical data of the patients were collected: sex, age, affected side, fracture classification, treatment method, operation time, follow-up period, complications, removal time of implant, shoulder DASH score and Constant score.If the measured data conform to normal distribution or approximate normal distribution, Student's T test method can be used to record the data in the form of mean 鹵standard deviation.If the measurement data do not conform to the normal distribution, rank sum test analysis is used and recorded in the form of median (quartile spacing).The count data were recorded in absolute value (percentage) and analyzed by using c 2 chi-square test and Fisher exact probability method.SPSS software 17. 0, USA) was used to process the data, and the test level was 0. 05% on both sides.Result 1.The mean age of the patients in the plate group was 42.2 years old, and that in the intramedullary nail group was 39.4 years old and 18-65 years old. The age of the two groups was normal distribution, and there was no significant difference between the two groups.The main injury mechanisms are: fall, sports injury, car accident, bicycle fall, the two groups of patients with various fracture mechanisms have no statistical significance. 3.According to OTA classification, there was no significant difference between the two groups in the proportion of type A and B fractures.The operative time in the intramedullary nail group was 36.93 鹵8.32 minutes vs 56.91 鹵7.77 minutes, the difference between the two groups was statistically significant, the X-ray exposure time of the two groups was normal distribution, the operative time of the intramedullary nail group was 36.93 鹵8.32 minutes vs 56.91 鹵7.77 minutes.The X-ray exposure time of the intramedullary nail group was 8.32 鹵1.93 seconds VS6.70 鹵1.17 seconds, the difference was statistically significant, the blood loss of the two groups was measured by rank sum test, the blood loss in the intramedullary nail group was 25.00 ml vs 122.50 ml less than that in the plate group, and the difference was statistically significant.The bone healing time of the two groups was shorter than that of the steel plate group by rank sum test, and the difference was statistically significant (P < 0.05).There was no significant difference in the incidence of postoperative complications between plate group and intramedullary nail group.The Constant score of shoulder joint in intramedullary nail group was better than that in plate group at 1 month, 3 months and 6 months after operation, and the difference was statistically significant.The DASH score of shoulder joint in intramedullary nail group was better than that in plate group at 1 month, 3 months and 6 months after operation, and the difference was statistically significant.At 12 months after operation, there was no significant difference in DASH score and Constant score between the two groups.All patients in the intramedullary nail group removed the internal fixation after operation, while 18 patients in the plate group took out the internal fixation.Conclusion compared with plate internal fixation, the minimally invasive screw screw has the advantages of simple operation, less trauma, ideal reduction, reliable fixation, early recovery, shorter healing time, less postoperative complications and less secondary hospitalization.To reduce the physical, mental and economic burden of patients, the operation is not difficult, suitable for grass-roots hospitals to promote the use.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 王永清;徐占敏;郭科民;楊志強(qiáng);戰(zhàn)穎;熊超;白賓;陳洪衛(wèi);王京生;;螺紋彈性髓內(nèi)釘閉合復(fù)位內(nèi)固定治療鎖骨骨折[J];中華骨科雜志;2010年01期

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本文編號(hào)：1702891