【摘要】：目的:對比研究新型META-NAIL脛骨髓內(nèi)釘髕上入路與經(jīng)髕韌帶入路脛骨髓內(nèi)釘閉合復(fù)位內(nèi)固定術(shù)治療脛骨骨折的臨床療效。方法:回顧性分析自2014年12月到2016年10月山東省中醫(yī)院創(chuàng)傷骨科治療的40例具有完整資料的脛骨骨折的住院患者,隨機分為A、B兩組,每組20例,A組行新型META-NAIL髕上入路脛骨髓內(nèi)釘閉合復(fù)位內(nèi)固定術(shù),B組行經(jīng)髕韌帶入路脛骨髓內(nèi)釘閉合復(fù)位內(nèi)固定術(shù)。通過比較兩組手術(shù)時間、術(shù)中透視次數(shù)、術(shù)中的出血量、骨折愈合率、術(shù)后髕前痛并根據(jù)Johner-Wuchs評分標(biāo)準(zhǔn)評判兩組患者術(shù)后功能。結(jié)果:所有患者均獲得隨訪,隨訪時間為9～12個月,平均為10.3個月,隨訪期間均未發(fā)現(xiàn)髓內(nèi)釘、螺釘斷裂。3例患者出現(xiàn)延遲愈合,1例出現(xiàn)畸形愈合,其中A組1例延遲愈合,B組2例,B組患者出現(xiàn)1例畸形愈合。術(shù)后12個月隨訪,A組骨折愈合率100%,B組骨折愈合率95%,A組與B組的骨折愈合率(p=0.4320.05)無統(tǒng)計學(xué)意義。A組手術(shù)時間:70～180分鐘,平均122.2分鐘;B組手術(shù)時間:90～215分鐘,平均158.5分鐘,兩組手術(shù)時間(p=0.020.05)有統(tǒng)計學(xué)差異。A組術(shù)中出血量:60～150ml,平均86.15ml;B組術(shù)中出血量:65～120ml,平均90.5ml,兩組術(shù)中出血量(p=0.4650.05)無統(tǒng)計學(xué)意義。A組術(shù)中透視次數(shù):12～30次,平均18.8次;B組術(shù)中透視次數(shù):26～50次,平均35.35次。兩組術(shù)中透視次數(shù)(p=0.0010.05)有統(tǒng)計學(xué)意義。A組術(shù)后髕前痛出現(xiàn)1例,B組5例。兩組髕前痛出現(xiàn)率(P=0.0240.05)有統(tǒng)計學(xué)意義。Johner-Wuchs評分標(biāo)準(zhǔn)評判兩組患者術(shù)后功能,78-100分A組:優(yōu),16例,良,4例;B組:優(yōu)12例,良,7例,差,1例。A組優(yōu)良率100%,B組優(yōu)良率95%,兩組優(yōu)良率(p=0.4320.05)無統(tǒng)計學(xué)意義。結(jié)論:對于脛骨骨折的手術(shù)治療,無論采用新型META-NAIL脛骨髓內(nèi)釘閉合復(fù)位內(nèi)固定術(shù)髕上入路還是采用脛骨髓內(nèi)釘經(jīng)髕韌帶入路均能取得良好療效;A組比B組術(shù)中透視次數(shù)少,術(shù)后髕前痛率發(fā)生小,手術(shù)操作時間少,因此,新型META-NAIL脛骨髓內(nèi)釘髕上入路閉合復(fù)位內(nèi)固定術(shù)治療脛骨骨折,具有手術(shù)操作時間少、術(shù)中透視次數(shù)少,術(shù)后髕前痛發(fā)生率小的特點,在臨床上值得推廣使用。
[Abstract]:Objective: to compare the clinical effect of new META-NAIL tibial intramedullary nail supracrapatellar approach and transpatellar ligament approach for tibial fracture treated by closed reduction and internal fixation of tibial intramedullary nail. Methods: from December 2014 to October 2016, 40 patients with tibial fractures treated by Department of Orthopaedics, Shandong Provincial Hospital of traditional Chinese Medicine, were randomly divided into two groups. 20 cases of each group were treated with new META-NAIL supracrapatellar approach and group B with closed reduction and internal fixation of tibial intramedullary nail via patellar ligamentous approach, and group B with closed reduction and internal fixation of tibial intramedullary nail via patellar ligament approach. The time of operation, the times of fluoroscopy, the amount of blood lost during operation, the rate of fracture healing and the postoperative prepatellar pain were compared between the two groups. The postoperative function of the two groups was evaluated according to the Johner-Wuchs score. Results: all the patients were followed up for 9 ~ 12 months with an average of 10.3 months. No intramedullary nail was found during the follow-up. One patient in group A had delayed healing and 2 patients in group B had malunion. 12 months after operation, the fracture healing rate of group A was 100 and that of group B was 95. There was no significant difference between group A and group B. the operative time of group A was 122.2 minutes, and the average time of operation in group B was 158.5 minutes. There was significant difference in the operative time between the two groups (p0. 020.05). There was no significant difference in the intraoperative blood loss between the two groups (p0. 0. 020.05). The intraoperative blood loss of group A was 1: 60150 ml, with an average of 86. 15 ml. The average intraoperative blood loss of group B was 0. 65120 ml, with an average of 9. 5 ml. There was no significant difference in the amount of intraoperative bleeding between the two groups (p0. 4650.05). The average number of fluoroscopy in group B was 18.8 times, 2650 times (average 35.35 times). The times of fluoroscopy in both groups (p < 0.0010.05) were statistically significant. Group A had 1 case of prepatellar pain after operation and group B (5 cases). The incidence rate of prepatellar pain (P0. 024. 05) in two groups was statistically significant. Johner-Wuchs score was 78-100 points in group A: 16 cases were excellent, 4 cases were good, 12 cases were excellent, 7 cases were good. The excellent and good rate of group A was 100%. The excellent and good rate of group B was 950.The excellent and good rate of two groups (p0. 4320.05) had no statistical significance. Conclusion: for the treatment of tibial fractures, both new META-NAIL tibial intramedullary nail closed reduction and internal fixation and tibial intramedullary nail transpatellar approach can achieve good results. Group A has fewer times of fluoroscopy than group B. The incidence of prepatellar pain was small, and the operative time was less. Therefore, the new META-NAIL tibial intramedullary nailing closed reduction and internal fixation with suprapatellar nailing for tibial fracture had less operative time and less fluoroscopy during operation. The incidence of prepatellar pain is small, which is worth popularizing in clinic.
【學(xué)位授予單位】：山東中醫(yī)藥大學(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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