【摘要】：目的通過對交鎖髓內(nèi)釘與鎖定鋼板內(nèi)固定治療Fraser I型浮膝損傷脛骨側(cè)骨折的資料進行總結(jié),進一步分析兩種不同內(nèi)固定方法在手術(shù)平均時間、術(shù)中出血、出現(xiàn)骨痂時間、負重時間、平均愈合時間、術(shù)后療效、術(shù)后并發(fā)癥等方面是否有統(tǒng)計學(xué)意義,為Fraser I型浮膝損傷脛骨側(cè)骨折治療方法的選擇提供幫助。方法采用回顧性分析方法,選取河北省創(chuàng)傷骨科中心(唐山市第二醫(yī)院)2009年1月~2013年12月期間收治45例Fraser I型浮漆損傷患者。所有患者均為閉合性損傷。股骨側(cè)使用交鎖髓內(nèi)釘治療。根據(jù)脛骨側(cè)固定方式不同,將其分成兩組,交鎖髓內(nèi)釘組和鎖定鋼板組。隨訪12~36個月,平均24.5±1.5個月。交鎖髓內(nèi)釘組23例,其中男性13例,女性10例,年齡18~56歲,平均38.5±2.5歲。左側(cè)12例,右側(cè)11例。受傷原因:交通傷10例,高處墜落傷8例,壓砸傷5例;其中合并腹部臟器傷2例,胸部外傷2例;顱腦外傷1例。鎖定鋼板組22例,男12例,女10例;年齡18~58歲,平均38.5±2.5歲。左側(cè)10例,右側(cè)12例。受傷原因:交通傷11例,高處墜落傷7例,壓砸傷4例;其中合并腹部臟器傷3例,胸部外傷1例;顱腦外傷1例。比較兩種不同內(nèi)固定方法在手術(shù)平均時間、術(shù)中出血、出現(xiàn)骨痂時間、負重時間、平均愈合時間、術(shù)后療效、術(shù)后并發(fā)癥。結(jié)果45例患者均獲得隨訪。交鎖髓內(nèi)釘組和鎖定鋼板組在年齡,性別,左側(cè)與右側(cè),受傷原因等方面(P0.05)具有可比性沒有顯著差異。交鎖髓內(nèi)釘組手術(shù)平均時間為90.09±9.19min,鎖定鋼板組手術(shù)平均時間為94.73±10.39min,顯示兩者手術(shù)時間及術(shù)后并發(fā)癥方面無顯著差異(P0.05)。按Karlstrom和Olerud功能標準評價,交鎖髓內(nèi)釘組:優(yōu)為18例,良為2例,中為3例,差為0例,優(yōu)良率為87%;鎖定鋼板組:優(yōu)為11例,良為2例,中為7例,差為2例,優(yōu)良率為59.1%,交鎖髓內(nèi)釘術(shù)后優(yōu)良率較鎖定鋼板組高。在術(shù)中出血量、出現(xiàn)骨痂時間、負重時間、平均愈合時間相比,交鎖髓內(nèi)釘組:分別為248.74±43.23ml、2.16±0.45個月、3.22±0.45個月、11.30±1.94個月。鎖定鋼板組:分別為322.95±43.39ml、2.94±0.45個月、4.83±0.69個月、13.42±1.66個月。兩組相比,交鎖髓內(nèi)釘組均較鎖定鋼板組短,之間的差異具有統(tǒng)計學(xué)意義(P0.05)。結(jié)論除手術(shù)時間與術(shù)后并發(fā)癥差異無統(tǒng)計學(xué)意義,在術(shù)中出血量、出現(xiàn)骨痂時間、負重時間、平均愈合時間、術(shù)后優(yōu)良率等方面,交鎖髓內(nèi)釘組都明顯優(yōu)于鎖定鋼板組。交鎖髓內(nèi)釘組,增大了早期功能鍛煉的可能性,骨折愈合得到有效促進,肌肉萎縮和關(guān)節(jié)僵直等并發(fā)癥的發(fā)生率得到遏制。雖然交鎖髓內(nèi)釘和鎖定鋼板從力學(xué)及生物學(xué)角度促使骨折愈合,有其各自的特點與適應(yīng)癥,但是交鎖髓內(nèi)釘具有固定穩(wěn)定,便于骨折愈合,降低感染率,減少失血量,降低內(nèi)固定失敗率等優(yōu)勢,可作為長骨簡單骨干骨折的首選方法。
[Abstract]:Objective to summarize the data of interlocking intramedullary nail and locking plate fixation in the treatment of tibial lateral fracture with Fraser type I floating knee injury, and to analyze the mean operative time, bleeding and callus time of two different internal fixation methods. The weight loading time, average healing time, postoperative curative effect and postoperative complications were statistically significant, which could be helpful for the treatment of tibial side fracture with Fraser type I floating knee injury. Methods by retrospective analysis, 45 patients with Fraser type I floating lacquer injury were selected from the trauma orthopedic center of Hebei Province (Tangshan second Hospital) from January 2009 to December 2013. All patients had closed injury. The femoral side was treated with interlocking intramedullary nail. According to the different way of tibial lateral fixation, they were divided into two groups: interlocking intramedullary nail group and locking plate group. The follow-up was 12 ~ 36 months with an average of 24.5 鹵1.5 months. There were 23 cases in the interlocking intramedullary nail group, including 13 males and 10 females, aged 1856 years (mean 38.5 鹵2.5 years). Left 12 cases, right 11 cases. There were 10 cases of traffic injury, 8 cases of falling injury and 5 cases of crush injury, including 2 cases of abdominal organ injury, 2 cases of chest injury and 1 case of craniocerebral injury. In the locking plate group, 22 cases were male (12 cases) and female (10 cases), the age was 1858 years (mean 38.5 鹵2.5 years). There were 10 cases on the left side and 12 cases on the right side. There were 11 cases of traffic injury, 7 cases of falling injury and 4 cases of crush injury, including 3 cases of abdominal organ injury, 1 case of chest injury and 1 case of craniocerebral injury. The mean operative time, intraoperative bleeding, callus time, weight loading time, average healing time, postoperative efficacy and postoperative complications were compared between the two internal fixation methods. Results all 45 patients were followed up. There was no significant difference in age, sex, left and right side, injury cause and so on between interlocking intramedullary nail group and locking plate group (P0.05). The mean operative time of interlocking intramedullary nail group was 90.09 鹵9.19 min, and that of locking plate group was 94.73 鹵10.39 min. There was no significant difference in operative time and postoperative complications between the two groups (P0.05). According to Karlstrom and Olerud functional criteria, the results of interlocking intramedullary nail group were excellent in 18 cases, good in 2 cases, moderate in 3 cases, poor in 0 cases, and excellent and good rate was 87%. In locking plate group, 11 cases were excellent, 2 cases were good, 7 cases were moderate, 2 cases were poor, the excellent and good rate was 59.1%. The excellent and good rate of interlocking intramedullary nail was higher than that of locking plate group. The blood loss, callus time, weight loading time and average healing time were 248.74 鹵43.23 ml, 2.16 鹵0.45 months, 3.22 鹵0.45 months and 11.30 鹵1.94 months respectively in the interlocking intramedullary nail group. The locking plate group was 322.95 鹵43.39 ml / L 2.94 鹵0.45 months, 4.83 鹵0.69 months and 13.42 鹵1.66 months respectively. Compared with the two groups, the interlocking intramedullary nail group was shorter than the locking plate group, the difference was statistically significant (P0.05). Conclusion there was no significant difference between the operative time and postoperative complications. The intramedullary interlocking nail group was superior to the locking plate group in terms of blood loss, callus time, weight loading time, average healing time and postoperative excellent and good rate. In interlocking intramedullary nail group, the possibility of early functional exercise was increased, fracture healing was effectively promoted, and the incidence of complications such as muscular atrophy and joint stiffness was restrained. Although interlocking intramedullary nails and locking plates have their own characteristics and indications for fracture healing in terms of mechanics and biology, interlocking intramedullary nails have stable fixation, facilitate fracture healing, reduce infection rates, and reduce blood loss. Reducing the failure rate of internal fixation can be the first choice for simple long bone fractures.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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