發(fā)布時(shí)間：2018-05-26 01:02

  本文選題：粉碎型髕骨骨折 + Cable-pin系統(tǒng)AO張力帶系統(tǒng)�。� 參考：《山東中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:前瞻性地探討及比較Cable-pin和張力帶系統(tǒng)兩種方式治療閉合性粉碎型髕骨骨折的臨床療效分析。以便獲取治療閉合性粉碎型髕骨骨折的臨床療效的最佳手術(shù)方案,并為臨床手術(shù)方案提供全面的參考。方法:根據(jù)提前設(shè)計(jì)好的臨床試驗(yàn)方案,依據(jù)納入排除標(biāo)準(zhǔn),篩選山東中醫(yī)藥大學(xué)附屬醫(yī)院骨科病房自2015年3月至2016年3月期間收治的閉合性粉碎型髕骨骨折患者符合標(biāo)準(zhǔn)的62例病例,隨機(jī)分為A、B兩組,其中A組患者為觀(guān)察組,B組患者為對(duì)照組,A組患者選用Cable-pin系統(tǒng),B組患者選用張力帶系統(tǒng),同時(shí)AB兩組患者在住院過(guò)程中均行中藥輔助療法。觀(guān)察組和對(duì)照組患者分別于術(shù)后15天、30天、60天、90天、120天隨訪(fǎng),復(fù)查行臨床體格檢查及膝關(guān)節(jié)正側(cè)位片,采用改良Bostman髕骨骨折臨床療效評(píng)估標(biāo)準(zhǔn),分別從膝關(guān)節(jié)活動(dòng)范圍、疼痛、工作、股四頭肌萎縮、助行、滲出、打軟腿、上下樓梯,并填寫(xiě)隨訪(fǎng)患者回訪(fǎng)表。結(jié)果:(1)在作為本次研究對(duì)象的62例患者中,均進(jìn)行了隨訪(fǎng),在此期間,皆達(dá)到骨折的臨床愈合標(biāo)準(zhǔn)。(2)術(shù)后120天觀(guān)察組A組患者Bostman評(píng)分平均82.57±9.20分,其中優(yōu)15例,良13例,中3例,差0例,優(yōu)良率為90.32%;B組患者Bostman評(píng)分平均73.90±14.26分,其中優(yōu)14例,良11例,中3例,差3例,優(yōu)良率為80.65%,膝關(guān)節(jié)功能評(píng)分A組高于B組8.67分,優(yōu)良率A組高于B組9.67%。組間差異采用卡方檢驗(yàn),P=0.046,有統(tǒng)計(jì)學(xué)意義。(3)在手術(shù)時(shí)間,固定難易程度、愈合時(shí)間方面無(wú)明顯差異(4)在術(shù)后隨訪(fǎng),功能活動(dòng)和并發(fā)癥方面,A組優(yōu)于B組,有統(tǒng)計(jì)學(xué)意義。結(jié)論:綜合以上具體數(shù)據(jù),Cable-pin系統(tǒng)和張力帶系統(tǒng)治療粉碎型髕骨骨折均獲得良好效果,在手術(shù)持續(xù)時(shí)間和患者術(shù)后愈合時(shí)間無(wú)明顯差異,然根據(jù)其術(shù)后并發(fā)癥,膝關(guān)節(jié)活動(dòng)功能以及依據(jù)Bostman評(píng)分標(biāo)準(zhǔn),Cable-pin系統(tǒng)治療相對(duì)較好,但其價(jià)格相對(duì)較高,因此我們應(yīng)當(dāng)結(jié)合患者實(shí)際情況,綜合評(píng)判,征得患者同意,實(shí)施較為合理、全面的最佳方案。
[Abstract]:Objective: to explore and compare the clinical efficacy of Cable-pin and tension band system in the treatment of closed comminuted patella fracture. In order to obtain the best surgical treatment of closed comminuted patella fracture, and to provide a comprehensive reference for clinical operation. Methods: according to the clinical trial plan designed in advance, according to the inclusive exclusion criteria, From March 2015 to March 2016, 62 cases of closed comminuted patella fracture in orthopedic ward of affiliated Hospital of Shandong University of traditional Chinese Medicine were selected. Group A was the observation group, group B was the control group, group A selected the Cable-pin system and group B selected the tension band system. Meanwhile, the AB group were treated with Chinese medicine adjuvant therapy in the course of hospitalization. The patients in the observation group and the control group were followed-up 15 days, 30 days, 60 days, 90 days and 120 days after operation. The patients in the observation group and the control group were followed up with clinical physical examination and lateral film of knee joint respectively. The modified Bostman criteria for evaluating the clinical efficacy of patellar fracture were adopted, respectively, from the range of knee joint movement and pain. Work, quadriceps femoris atrophy, walking aid, exudation, soft legs, up and down stairs, and fill in follow-up visit form. Results in the 62 patients who were the subjects of this study, all the patients were followed up. During this period, all of them met the standard of fracture healing. The average Bostman score of group A was 82.57 鹵9.20 days after operation, including excellent 15 cases, good 13 cases, fair 3 cases, the average value of Bostman in group A was 82.57 鹵9.20 days after operation. The average Bostman score of group B was 73.90 鹵14.26, including excellent 14 cases, good 11 cases, fair 3 cases, poor 3 cases, excellent and good rate 80.65. The knee joint function score of group A was higher than that of group B 8.67, and the excellent and good rate of group A was higher than that of group B 9.67. There was no significant difference in operation time, fixation difficulty and healing time between the two groups (P < 0.01). 4) Group A was superior to group B in terms of postoperative follow-up, functional activity and complications. Conclusion: the treatment of comminuted patellar fracture with Cable-pin system and tension band system has good results. There is no significant difference in the duration of operation and the time of healing after operation, but according to the postoperative complications, there is no significant difference in the treatment of comminuted patellar fracture. The treatment of knee motion function and Cable-pin system according to Bostman scoring criteria is relatively good, but its price is relatively high. Therefore, we should combine the actual situation of patients, comprehensive evaluation, with the consent of patients, the implementation of a more reasonable and comprehensive best plan.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687.3

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本文編號(hào)：1935335