本文選題：外踝骨折　切入點：分型　出處：《吉林大學》2017年碩士論文

【摘要】：解剖鎖定鋼板及髓內釘治療外踝骨折Danis-weber B及C型骨折比較研究背景:外踝骨折治療需視為關節(jié)內骨折進行治療,為了盡量減低術后關節(jié)僵硬、創(chuàng)傷性關節(jié)炎等并發(fā)癥,治療原則上需給予骨折處解剖復位、堅強內固定及術后早期功能鍛煉。對于外踝骨折存在多種治療方案及內固定方法,切開復位合并鋼板內固定的治療是常用的治療方法,手術操作對醫(yī)師的技術要求不高,可在直視下復位骨折達到解剖復位,但術后并發(fā)癥相對較高。隨著mippo技術理念的深入及內固定材料種類變化,髓內釘治療外踝骨折提供了新的備選方案,由于其手術要求的切口相對較小,而且術后出現并發(fā)癥的幾率也較小,但對醫(yī)師的操作技術要求較高,能提供良好的影像學結果和功能恢復。目的:外踝骨折Danis-Weber B及C型骨折,分別采用Synthes解剖鎖定鋼板及Acumed腓骨髓內釘固定的相關問題進行比較。方法:分析2014年01月—2016年04月在吉林大學第一醫(yī)院100例外踝骨折分別采用解剖鎖定鋼板及髓內釘治療比較。記類采用Danis-Weber分型,針對B及C型外踝骨折,采用解剖鎖定鋼板60例,采用髓內釘40例,對病例性別、年齡、軟組織情況及關節(jié)脫位、住院日、手術時間、出血、切口愈合情況、是否合并感染、骨折復位、骨折愈合、踝關節(jié)功能等進行觀察。結果:兩組手術醫(yī)師分別完成外踝使用Synthes解剖鎖定鋼板及Acumed髓內釘的患者在性別、年齡、軟組織情況及關節(jié)脫位等方面差異無統(tǒng)計學意義(P0.05)。平均住院日及骨折愈合時間上差異無統(tǒng)計學意義(P0.05)。骨折復位標準均達到解剖復位。Baird-Jackson踝關節(jié)評分在疼痛、行走能力、踝關節(jié)穩(wěn)定、跑步能力、工作能力、踝關節(jié)活動范圍、X線片評估骨折復位結果及總分上差異無統(tǒng)計學意義(P0.05),手術時間、手術出血量、切口長度、切口并發(fā)癥等方面有統(tǒng)計學意義(P0.05),由于使用內固定物材料非一種材質及受骨折合并類型影響,住院費暫時無比較意義。結論:在外踝骨折Danis-Weber B及C型骨折中,髓內釘相比解剖鎖定鋼板是更為高效的辦法,能夠較少手術出血量及降低手術切口并發(fā)癥。對于大多數的外踝骨折,切開復位鋼板內固定仍然是常規(guī)的固定手段,適應癥廣,能使腓骨遠端骨折達到解剖復位,且固定可靠,取得良好的功能恢復,臨床操作相對簡單,選取鋼板為內固定物材料、由于在骨折處行手術切口,受骨折處軟組織條件影響較大,術后出現皮緣壞死、鋼板外露、甚至感染幾率相比髓內針升高。髓內釘為閉合復位,操作技術要求較高,需要一定的硬件設施且術中透視次數較多,骨折復位情況較解剖鋼板略差。微創(chuàng)閉合復位利于保護軟組織及較少骨膜剝離,減少骨折血運破壞,利于骨折愈合,減少皮膚壞死及感染可能;髓內縱向固定,符合生物力學穩(wěn)定性,術后早期功能鍛煉,二次手術易取出。內固定不適性小,較少要求取出,但最終兩組骨折的臨床愈合時間以及遠期踝關節(jié)功能的恢復無明顯差異。臨床工作中,需要根據患者的經濟條件及依從性、軟組織條件、骨折類型等具體情況合理選擇內固定方法及材料。
[Abstract]:Anatomical locking plate and intramedullary nail in the treatment of Danis-weber type C and B fractures of the lateral malleolus fracture of lateral malleolus: comparative study on background therapy should be treated as intra-articular fracture, in order to minimize postoperative ankylosis, traumatic arthritis and other complications, the treatment principle should be given fracture anatomical reduction, rigid fixation and early postoperative function exercise. For a variety of treatment programs and the methods of internal fixation of lateral malleolus fracture, incision reduction plate fixation is associated with the common treatment, the operation requirements of medical technology is not high, in the direct manipulation of the fracture anatomical reduction, but the complications are relatively high. With the change of type MIPPO technology concept deeply and internal fixation, intramedullary nail in the treatment of lateral malleolus fractures provide new alternatives, because of its relatively small incision operation requirements, and postoperative complications of the few The rate is also smaller, but the operation technology of medical demand is higher, can provide good imaging results and recovery function. Objective: Danis-Weber B lateral malleolus fractures and C fractures, were used to compare Synthes anatomic locking plate fixation nail related problems and Acumed. Methods: the fibular bone marrow of 2014 01 - 04 2016 in No.1 Hospital of Jilin University 100 cases of ankle fractures by anatomical locking plate and intramedullary nail in the treatment of class. Note the Danis-Weber classification, the B and C type lateral malleolus fractures with anatomical locking plate in 60 cases, with an intramedullary nail in 40 cases, the age of patients, gender, soft tissue and joint dislocation, hospitalization days, the operation time, bleeding, wound healing, infection, fracture reduction, fracture healing, ankle joint function were observed. Results: the two groups of surgeons were completed using Synthes lateral anatomical locking plate and Ac Umed intramedullary nail in patients with gender, age, no statistically significant difference between soft tissue and joint dislocation and so on (P0.05). The average hospitalization days and healing time had no significant difference (P0.05). Fracture reduction standard anatomic reduction was achieved in.Baird-Jackson ankle joint scoring ability to walk in pain, and ankle joint stability running ability, work ability, range of motion of the ankle, X-ray evaluation of fracture reduction results and total score difference was not statistically significant (P0.05), operation time, bleeding volume, incision length, incision complications had statistical significance and other aspects (P0.05), due to a non material and by using internal fixation combined with fracture type materials, hospital fees temporarily no comparison significance. Conclusion: Danis-Weber B and C in the lateral malleolus fracture, intramedullary nail with anatomical locking plate is a more efficient method to do, less amount of bleeding The surgical incision and reduce the complications. For most of the lateral malleolus fracture, internal fixation is still fixed conventional means, wide indications, the anatomical reduction of the distal fibula fracture, and fixed reliable, good functional recovery, clinical operation is relatively simple, for selecting plate internal fixation materials, due to the fractures. Surgical incision, fracture by soft tissue conditions affected the edge of skin necrosis after operation, plate exposure, even the infection rate increased. Compared to intramedullary nail intramedullary nail for closed reduction operation, higher technical requirements, need certain hardware facilities and intraoperative fluoroscopy times more reduction slightly worse than the anatomical plate fracture minimally invasive closed reduction. To protect the soft tissue and less periosteal stripping, reduction of blood supply damage, conducive to fracture healing, reduce skin necrosis and infection; intramedullary fixation with longitudinal, biomechanics Stability, early postoperative functional exercise, the two operation easy to remove the internal fixation. The discomfort of small, less demanding out, but in the end of two groups of fracture healing time and long-term ankle function recovery. No significant differences in the clinical work, according to the economic conditions of patients and compliance, soft tissue conditions reasonable selection of internal fixation methods and material fracture type specific circumstances.

【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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