本文選題：脛骨骨折 + 髕上入路�。� 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:研究討論髓內(nèi)釘治療脛骨骨折術(shù)后影響脛骨力線的相關(guān)因素。方法:回顧性分析2013年1月至2015年12月收治于大連醫(yī)科大學(xué)附屬第一醫(yī)院創(chuàng)傷骨科的確診為脛骨骨折患者94例,年齡18～87歲,平均(44.73±48.79)歲,其中男75例,女19例,雙側(cè)脛骨骨折2例,共計96側(cè)脛骨骨折。其中開放性骨折14例,閉合性骨折82例。依據(jù)手術(shù)切口分髕上入路治療組及髕下入路治療組,腓骨固定與否分為腓骨固定組與非固定組,以遠端鎖定釘數(shù)量分為2枚組,3枚組,依據(jù)AO/OTA分型分為A型組、B型組、C型組。統(tǒng)計患者性別、年齡、手術(shù)時間、出血量、住院天數(shù)、骨折分型、術(shù)中是否使用輔助復(fù)位工具、髓內(nèi)釘遠端鎖定釘數(shù)量、腓骨是否固定等,測量術(shù)后脛骨冠狀位、矢狀位力線。結(jié)果:各組年齡、住院天數(shù)、手術(shù)時長、出血量、性別差異無統(tǒng)計學(xué)差異(P0.05),組間具有可比性。腓骨固定不固定兩組間術(shù)后脛骨矢狀位力線差異無統(tǒng)計學(xué)意義(P0.05),兩組間術(shù)后脛骨冠狀位力線差異有統(tǒng)計學(xué)意義(P0.05),腓骨固定組術(shù)后脛骨冠狀位力線優(yōu)于腓骨不固定組。遠端鎖定釘數(shù)兩組間術(shù)后脛骨冠狀位力線、術(shù)后脛骨矢狀位力線差異無統(tǒng)計學(xué)意義(P0.05)。髕上組與髕下組兩組術(shù)后脛骨力線無顯著差異,但僅對脛骨干骺端骨折對比時,兩組間術(shù)后脛骨冠狀位力線、矢狀位力線差異具有統(tǒng)計學(xué)意義(P0.05),髕上組術(shù)后脛骨冠狀位力線、矢狀位力線優(yōu)于髕下組的。脛骨中段骨折髕上組與髕下組兩組間術(shù)后脛骨冠狀位力線、術(shù)后脛骨矢狀位力線差異沒有統(tǒng)計學(xué)意(P0.05)。A型、B型、C型三組通過方差分析,在冠狀位上不同分型組間沒有統(tǒng)計學(xué)差異,但在矢狀位上有統(tǒng)計學(xué)意思。對三組在矢狀位上進行組間比較,僅A組與B組之間有統(tǒng)計學(xué)意義(P0.05),A組與C組、B組與C組無統(tǒng)計學(xué)意義。結(jié)論:脛骨干骺端骨折時,髕上入路在恢復(fù)和維持脛骨力線方面優(yōu)于髕下組。腓骨固定與否在矢狀位上雖然沒有明顯差異,但在冠狀位上固定組力線要優(yōu)于不固定組。所以對于脛腓骨同時骨折時,尤其是骨折線離踝關(guān)節(jié)平面較近時,應(yīng)固定腓骨。而對于遠端鎖定釘數(shù),其與術(shù)后脛骨力線關(guān)系不大,但遠期在維持骨折復(fù)位上是否滿意還需要更多的探究。分型中,診斷為42-A型的脛骨骨折術(shù)后力線相對較好,越復(fù)雜的脛骨骨折,其術(shù)后脛骨力線不齊發(fā)生率相對較高。
[Abstract]:Objective: to study the factors influencing tibial force line after tibial fracture treated by intramedullary nail. Methods: from January 2013 to December 2015, 94 patients with tibial fractures were treated in Department of Trauma and Orthopaedics, first affiliated Hospital of Dalian Medical University, with an average age of (44.73 鹵48.79) years (75 males and 19 females). Two cases of bilateral tibial fractures, a total of 96 sides of tibial fractures. There were 14 cases of open fracture and 82 cases of closed fracture. The fibula fixation group was divided into fibula fixation group and non-fixed group according to the operative incision. According to the number of distal locking nails, the fibula fixation group was divided into two groups: group C, group A and group B, according to AO/ OTA classification. Sex, age, operation time, bleeding volume, hospital stay, fracture classification, whether assistant reduction tools were used during operation, the number of distal locking nails of intramedullary nail, fibula fixation and so on were counted. The tibial coronal position and sagittal force line were measured. Results: there was no significant difference in age, hospital stay, operation duration, bleeding volume and sex (P0.05) between the groups. There was no significant difference in tibial sagittal force line between the two groups (P0.05), but there was significant difference between the two groups (P0.05). The tibial coronal force line in fibula fixation group was better than that in fibula unstable group. There was no significant difference in tibial coronal force line and tibial sagittal force line between the two groups (P0.05). There was no significant difference in tibial force line between the supratellar group and the subpatellar group, but only for the tibial metaphyseal fracture, the tibial coronal force line and sagittal force line were significantly different between the two groups (P0.05), and the tibial coronal force line was significantly different between the two groups (P0.05). Sagittal force line was superior to infrapatellar group. The tibial coronal force line and tibial sagittal position force line were not significantly different between the two groups in the middle tibial fracture group and the subpatellar fracture group (P0.05). There was no significant difference in the tibial coronal position between the three groups by ANOVA (P0.05) .There was no significant difference between the three groups in different types of tibial tibia in coronal position. But there is statistical meaning in sagittal position. The sagittal position of the three groups was compared only between group A and group B (P0.05) there was no significant difference between group A and group C (group B and C). Conclusion: the superior patellar approach is superior to the subpatellar group in restoring and maintaining the tibial force line in the fracture of tibial metaphysis. Although there was no significant difference in the sagittal position of fibula fixation, the force line of the fixation group in the coronal position was better than that in the unfixed group. Therefore, fibula should be fixed when the tibia and fibula are fractured at the same time, especially when the fracture line is close to the ankle. However, the number of distal locking nails is not related to the tibial force line after operation, but whether the fracture reduction is satisfactory or not in the long term still needs more exploration. In the classification of tibial fractures diagnosed as 42-A, the postoperative force lines were relatively good, and the more complex tibial fractures, the higher the incidence of postoperative tibial force-line unevenness.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3
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本文編號：2058488