本文選題：可吸收內固定材料 + 關節(jié)周圍骨折　； 參考：《吉林大學》2015年碩士論文

【摘要】：目的：通過可吸收釘對骨折的手術治療的回顧性分析，探究可吸收內固定物使用的術中注意事項和操作技巧。 方法：本文共收集吉林大學中日聯(lián)誼醫(yī)院骨科2012年10月-2014年11月收治的關節(jié)周圍骨折患者26例，均使用可吸收內固定物（可吸收釘、可吸收接骨板、可吸收固定棒）手術治療。回顧性分析每名患者術前術后的關節(jié)功能、手術并發(fā)癥及影像學資料。其中男，18例，女，8例；年齡19-56歲，平均38.35歲；股骨頭骨折7例，內踝骨折5例（其中3例合并外踝骨折，1例合并后踝骨折），脛骨平臺骨折2例，外踝骨折2例，距骨骨折4例，肩關節(jié)斯脫骨折2例，跖骨骨折2例，，股骨髁撕脫骨折1例，髕骨骨折1例。26例患者有20例有不同程度的復合損傷，及時積極處理合并損傷，于1~2周內行骨折切開復位可吸收內固定器材固定術，術中手術器械、材料配套，根據(jù)骨折部位、特點及分型選擇與之適應的手術入路,術中充分暴露欲處理的骨折，盡量做到術野清晰且損傷相對較小,必要時可切開關節(jié)囊來更好的復位關節(jié)面，骨折復位良好后盡量修復關節(jié)囊及周圍韌帶。按照規(guī)范操作和符合AO骨折固定原理。手術操作技術規(guī)范。術后在醫(yī)師指導下適當功能鍛練，必要時輔以外固定輔助功能鍛練。所有患者術前均行高質量數(shù)字成像（DR）或關節(jié)部位的三維CT及表面重建。術后1-2天內行DR復查，術后1、3、6、12個月復查x線片，4-24個月隨訪，通過查體、患者反饋資料、及術后定期復查的x線片判斷骨折愈合情況，同時記錄相應、相關處理方法、并發(fā)癥及病情轉歸情況。所有患者均根據(jù)美國骨科協(xié)會(AAOS)關節(jié)功能評價標準,分為4級,優(yōu):關節(jié)活動正常,無疼痛,生活完全自理;良:關節(jié)活動度為75%,輕度疼痛,不影響工作和生活;可:關節(jié)活動度為50%,中度疼痛,工作和生活收影響;差:關節(jié)活動度5%,劇烈疼痛,明顯影響工作和日常生活。將所得術前術后相關資料進行統(tǒng)計學分析。 結果:手術過程中：3例患者于手術過程中出現(xiàn)斷釘；2例患者于手術過程中出現(xiàn)螺釘對骨折塊把持欠佳，螺釘松動；2例患者于手術植釘過程中出現(xiàn)植入阻力過大剩余釘尾無法繼續(xù)植入。術后：26例患者均術后隨訪，隨訪時間4-24個月。大部分患者能按時（術后第1、3、6、12個月）復查，并且電話隨訪；少部分未能做到，只給予電話隨訪。其中1例因個人因素未按術后要求,未按醫(yī)師要求進行復診和康復鍛煉，電話隨訪無法完全獲知其恢復情況，1例患者未按醫(yī)師要求休養(yǎng)及功能鍛練，提前負重下地行走，骨折愈合欠佳，關節(jié)功能尚可，建議減少負重，延長隨訪半年，骨折愈合；2例出現(xiàn)骨折愈合后皮下釘帽未完全吸收，但未引起疼痛及炎性反應，予以切開摘除。其余患者治療效果良好，創(chuàng)口、骨折愈合良好，對關節(jié)功能恢復滿意，均能滿足日常工作和生活需要。手術前其中2例為可，24例為差。手術后其中1例為可，1例為良，24例為優(yōu)。優(yōu)良率96.15%.所有患者術前、術后關節(jié)功能評價分級均有提高。 結論： 1、可吸收釘適用于關節(jié)周圍骨折 2、可吸收釘治療關節(jié)周圍骨折的優(yōu)勢：無需二次取出、避免應力遮擋、無影像干擾、生物相容性好，無金屬組織殘留體內 3、應用可吸收內固定物治療關節(jié)周圍骨折術中規(guī)范操作及相關手術技術是手術成敗的關鍵。
[Abstract]:Objective: through retrospective analysis of the operative treatment of fracture by absorbable screws, to explore the matters needing attention and operative skills in the use of absorbable internal fixators.
Methods: a total of 26 patients with periarticular fractures treated in Department of orthopedics, Jilin University, China Japan Friendship Hospital, November -2014 October 2012, were treated with absorbable internal fixation (absorbable nail, absorbable plate, absorbable fixation rod). The joint function, surgical complications and image of each patient were analyzed retrospectively. Male, 18 cases, women, 8 cases; age 19-56 years old, average 38.35 years; 7 cases of femoral head fracture, 5 cases of internal malleolus fracture (including 3 cases with external malleolus fracture, 1 combined posterior ankle fracture), 2 cases of tibial plateau fracture, 2 cases of fracture of the ankle, 4 cases of talus fracture, 2 cases of shoulder joint fracture, 2 cases of metatarsal fracture, femoral condylar fracture fracture, and fracture of patella. Cases of.26 cases have 20 cases with different degree of complex injury, and timely and active treatment of combined injury, open reduction within 1~2 weeks can absorb internal fixation equipment fixation, surgical instruments, material matching, according to the fracture site, characteristics and classification of the adaptive hand approach, fully exposed fractures in the operation, try to do as much as possible. When the operation field is clear and the injury is relatively small, the joint capsule can be cut to better reposition the articular surface when necessary. The joint capsule and the surrounding ligament are repaired as far as possible after the fracture is good. According to the standard operation and conforming to the AO fracture fixation principle, the operation technical specification. After the operation, the functional training is suitable under the guidance of the doctor, and the auxiliary external fixation auxiliary work is supplemented when necessary. Able to exercise. All patients underwent high quality digital imaging (DR) or three-dimensional CT and surface reconstruction of joints. DR reexamination was performed within 1-2 days after operation, X-ray examination was performed at 1,3,6,12 months after operation, and 4-24 months followed up. Methods, complications and prognosis. All patients were divided into 4 grades according to the American Department of orthopedics Association (AAOS) joint function evaluation criteria, excellent: joint activities were normal, no pain, and life was completely self-care; good: joint activity was 75%, mild pain, no impact on work and life; but joint activity was 50%, moderate pain, work and life harvest. Poor: joint activity 5%, severe pain, obviously affect work and daily life. Preoperative and postoperative data will be statistically analyzed.
Results: during the operation, 3 patients had broken nails during the operation; 2 patients had poor screws on the fracture block and loosened the screws during the operation, and 2 patients were unable to continue implantation during the operation. After the operation, 26 patients were followed up after 4-24 months of follow-up. Some patients could be reexamined on time (1,3,6,12 month after operation) and followed up by telephone; only a few failed to be done and only a follow-up was given. 1 of them were not required to revisit and rehabilitate according to the requirements of the surgeon. The telephone follow-up could not be fully understood, and 1 patients were not required to recuperate and function according to the doctor's request. The fracture healing was not good and the joint function was still available. It was suggested to reduce the weight bearing, prolong the follow-up for half a year and heal the fracture. 2 cases were not completely absorbed by the nail cap after the healing of the fracture, but did not cause the pain and inflammatory reaction. The other patients had good treatment effect, the wound, fracture healing well and joint work. After operation, 2 cases were available and 24 cases were poor. After operation, 1 cases were available, 1 were good, 24 were excellent. The excellent rate of 96.15%. in all patients was improved before operation.
Conclusion:
1, the absorbable nail is suitable for the periarticular fracture
2, the advantages of absorbable screws in the treatment of periarticular fractures: no need for two removal, avoiding stress shielding, no image interference, good biocompatibility, and no residual metal tissue.
3, the application of absorbable internal fixators in the treatment of periarticular fractures is the key to the success or failure of the operation.

【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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本文編號：1798077