本文選題：有限切開復(fù)位 + 閉合復(fù)位�。� 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：目的： 隨著現(xiàn)代生活水平的提高，交通運(yùn)輸及地產(chǎn)建筑業(yè)的飛速發(fā)展，導(dǎo)致高能量性的損傷越來(lái)越多，由于下肢長(zhǎng)管狀骨解剖結(jié)構(gòu)和其特殊的生理作用，下肢長(zhǎng)管狀骨骨折也被越來(lái)越得到重視。當(dāng)前醫(yī)療水平不斷的提高，治療方式趨于多樣化，但我們對(duì)于保守治療失敗的下肢長(zhǎng)管狀骨折仍以手術(shù)治療為主，手術(shù)方式的選擇以傳統(tǒng)的鋼板固定及經(jīng)典髓內(nèi)固定為主。本文通過(guò)對(duì)下肢長(zhǎng)管狀骨折尤其是中段骨折交鎖髓內(nèi)針固定的病例資料進(jìn)行回顧性分析，通過(guò)對(duì)比閉合復(fù)位與有限切開復(fù)位髓內(nèi)固定治療下肢長(zhǎng)管狀骨折的手術(shù)時(shí)間及骨折愈合時(shí)間，探討交鎖髓內(nèi)針治療下肢長(zhǎng)骨骨折的臨床療效，尤其是下肢長(zhǎng)骨B、C型骨折。以期對(duì)這種臨床上較常見骨折的首次手術(shù)方式的選擇做出一定的理論指導(dǎo)，減輕患者術(shù)中手術(shù)時(shí)間長(zhǎng)及術(shù)后長(zhǎng)期臥床的痛苦。 資料與方法： 本文通過(guò)回顧性研究2012年4月～2014年8月期間，吉林大學(xué)中日聯(lián)誼醫(yī)院骨科創(chuàng)傷學(xué)組診治的外傷致下肢長(zhǎng)管狀骨骨折患者81例，經(jīng)篩選后得到53例，其中男31例，女21例，其中雙股骨中下段骨折1例；年齡23-77歲，，平均47.5歲。入選的標(biāo)準(zhǔn)：53例病例中，因A型骨折術(shù)中閉合復(fù)位失敗，選擇有限切開復(fù)位交鎖髓內(nèi)針內(nèi)固定術(shù)4例，余均為B、C型骨折中骨塊較大且移位明顯的患者27例。致傷原因中車禍傷31例，墜落傷11例，擠壓傷3例，摔傷8例；其中股骨中上段骨折32例，脛骨中上段骨折21例，多發(fā)傷患者24例。按照AO／OTA分類32A型5例，32B型15例，32C型6例，42A型7例，42B型11例，42C型9例。以交鎖髓內(nèi)針有限切開復(fù)位內(nèi)固定術(shù)為治療組，閉合復(fù)位術(shù)為對(duì)照組，平均隨訪18個(gè)月（最短6個(gè)月，最長(zhǎng)30個(gè)月）。所有骨折均為新鮮骨折,多發(fā)傷患者局部軟組織挫傷均較重，絕大多數(shù)患者無(wú)明顯骨質(zhì)缺損。手術(shù)時(shí)間為傷后5小時(shí)-3周，術(shù)中采取擴(kuò)髓、靜力固定【3】。 統(tǒng)計(jì)學(xué)方法： 應(yīng)用SPSS19.0統(tǒng)計(jì)軟件分析，計(jì)量資料用均數(shù)加減標(biāo)準(zhǔn)（X±S）表示，采用t檢驗(yàn)，計(jì)數(shù)資料用χ2檢驗(yàn)，以P＜0.05表示差異存在統(tǒng)計(jì)學(xué)意義。 結(jié)果： 治療組較對(duì)照組手術(shù)時(shí)間短，術(shù)中出血量少。 治療組較對(duì)照組骨折愈合時(shí)間短，患者術(shù)后臥床時(shí)間縮短。 治療組與對(duì)照組在骨折術(shù)后骨不連發(fā)生程度上無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)論： 有限切開復(fù)位交鎖髓內(nèi)針內(nèi)固定術(shù)治療下肢長(zhǎng)骨骨折適應(yīng)AO/OTA分型廣泛，且術(shù)中髓內(nèi)針能準(zhǔn)確置入并能準(zhǔn)確判斷骨折復(fù)位情況，明顯縮短手術(shù)時(shí)間及減少術(shù)中C臂透視引起的損傷，對(duì)骨質(zhì)缺損嚴(yán)重需要植骨的患者能一期給予植骨，減少因二期植骨手術(shù)而造成的自身創(chuàng)傷性傷害及患者經(jīng)濟(jì)負(fù)擔(dān)重的不良后果，并減少因切口暴露時(shí)間長(zhǎng)導(dǎo)致的術(shù)后感染，同時(shí)降低骨筋膜室綜合征發(fā)生的幾率，縮短術(shù)后康復(fù)時(shí)間，是一種穩(wěn)妥可行的方法。
[Abstract]:Objective: With the improvement of modern living standards and the rapid development of transportation and real estate construction industry, there are more and more high energy injuries due to the anatomical structure of the long tubular bone of the lower extremities and its special physiological function. Long-bone fractures of the lower extremities have also been paid more and more attention. At present, the medical treatment level is improving constantly, the treatment methods tend to be diversified, but we still treat the failure of conservative treatment of lower extremity long tubular fractures mainly by surgical treatment, the choice of surgical methods is the traditional plate fixation and classical intramedullary fixation. In this paper, the data of patients with long tubular fractures of lower extremity, especially those with interlocking intramedullary needle fixation, were analyzed retrospectively. By comparing the operative time and fracture healing time between closed reduction and limited open reduction and intramedullary fixation, the clinical effect of interlocking intramedullary needle in the treatment of lower extremity long bone fracture, especially the lower limb long bone type C fracture, was discussed. In order to make certain theoretical guidance on the choice of the first operation mode of this kind of common fracture in clinic, to alleviate the pain of long operation time and long-term bed-rest after operation. Information and methods: From April 2012 to August 2014, a retrospective study was conducted on 81 cases of lower extremity long bone fractures diagnosed and treated by Department of Orthopedics, Sino-Japanese Friendship Hospital of Jilin University. 53 cases were obtained after screening, including 31 males and 21 females. There was 1 case of double distal femur fracture, aged 23-77 years (mean 47.5 years). Among the 53 cases of type A fracture, 4 cases were treated with limited open reduction and interlocking intramedullary needle fixation because of the failure of closed reduction in type A fracture. The rest were 27 cases with large bone mass and obvious displacement in type B C fracture. The causes of injury included 31 cases of traffic accident, 11 cases of falling injury, 3 cases of crush injury, 8 cases of falling injury, including 32 cases of middle and upper femur fracture, 21 cases of middle and upper tibia fracture, 24 cases of multiple injury. According to AO/OTA classification, there were 5 cases of type 32A, 15 cases of type 32B, 6 cases of type 32C, 7 cases of type 42A, 11 cases of type 42B, 9 cases of type 42C. The treatment group was treated with limited open reduction and internal fixation with interlocking intramedullary needle and the control group with closed reduction. The average follow-up was 18 months (the shortest 6 months and the longest 30 months). All the fractures were fresh, the local soft tissue contusion was serious in the patients with multiple injuries, and there was no obvious bone defect in most of the patients. The operative time was 5 hours-3 weeks after injury. Reaming and static fixation were performed during the operation. Statistical methods: The statistical software of SPSS19.0 was used to analyze the statistical data. The statistical data were expressed by the standard of mean addition and subtraction (X 鹵S), the t test was used, the count data was analyzed by 蠂 2 test, and the difference was statistically significant (P < 0. 05). Results: The time of operation in the treatment group was shorter than that in the control group, and the amount of intraoperative bleeding was less. The healing time of fracture in the treatment group was shorter than that in the control group, and the bed-rest time of the patients after operation was shorter. There was no significant difference in the degree of nonunion after fracture between the treatment group and the control group. Conclusion: Limited open reduction and interlocking intramedullary needle fixation for lower extremity long bone fractures adapted to a wide range of AO/OTA classification, and intramedullary needle can be placed accurately and can accurately judge the reduction of fractures. The operative time was significantly shortened and the injury caused by C-arm fluoroscopy was reduced during the operation. Bone grafts could be given to patients with serious bone defect who needed bone grafting in one stage. To reduce the self-traumatic injury caused by secondary bone grafting and the adverse consequences of heavy financial burden on the patients, and to reduce the postoperative infection caused by the long time of incision exposure, and to reduce the probability of occurrence of osseous fascia syndrome. Shortening the time of postoperative rehabilitation is a safe and feasible method.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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