大众健康评分下的胫骨髓内钉术后疗效  

Therapeutic Effect of Intramedullary Tibial Nailing with Generic Health Score

作　　者：邹剑[1] 张长青[1] 

机构地区：[1]上海交通大学医学院附属第六人民医院骨科,上海市200233

出　　处：《组织工程与重建外科杂志》2009年第5期283-285,300,共4页Journal of Tissue Engineering and Reconstructive Surgery

摘　　要：目的使用大众健康评分及骨科专业关节评分,对单一胫骨干骨折髓内钉治疗的患者进行评分研究,比较两种方法之间的异同。方法选用自2005年3月至2006年3月,因胫骨干骨折在我院骨科取胫骨髓内钉的患者作为研究对象。骨折类型为单一下肢胫骨骨折及胫腓骨骨折。入选后收集其X片、了解受伤机制、骨折类型、手术切口入路、骨折愈合时间及并发症,同时对其进行临床评价,包括视觉评分法(VAS)、Iowa膝关节及踝关节评分、SF-36生活质量表,利用Spearman检验对部分变量进行相关性分析。结果本组共162例患者,术后平均随访38个月。60例患者休息时存在膝关节周围疼痛;103例患者由于进钉点疼痛而影响膝关节活动;31例患者出现不同程度踝关节周围疼痛;19例患者仍感骨折部位疼痛。膝关节与踝关节的VAS评分存在明显相关性(r=0.38),而两者与骨折部位的VAS评分均无相关性。膝、踝关节的Iowa评分与SF-36生活质量表的躯体总分及心理总分也存在极大的相关性。结论胫骨骨折髓内钉治疗术后,尽管医生认为手术效果较为肯定,但根据患者自身的评价,仍有较大比例的"不满意"率。Objective To investigate the clinical outcomes of intramedullary tibial nailing in the treatment of tibial fracture by using both generic health and disease specific scores and compare the relationship of two measures. Methods From March 2005 to March 2006, 162 patients with tibial fracture received the treatment of intramedullary tibial nailing. The mechanism and types of injury, operative incision, X-ray film, healed time of the incision and complications were studied. Iowa Knee and Ankle Scores, visual analogue pain scores and short form 36 health status questionnaire were adopted. Results All the patients were followed up for an average 36 months. Sixty （37.0%） patients had pain around the knee at rest,103 patients （63.5%） had difficulty in kneel activity, and 31 patients （19.1%） were still experiencing some pain at their fracture site; 69% of patients had excellent results based on the Iowa scores as well as the SF-36 scores. Pain at the knee correlated with low Physical Component Summary and Mental Component Summary scores, and fracture site pain correlated with only low Physical Component Summary score. There was a significant correlation between the disease-specific scores and the SF-36 scores, and only patients with an excellent Iowa grade had ＂normal＂ SF-36 scores. Conclusion After intramedullary tibial nailing, mild deficits registered by Iowa scores are associated with a significant disability and unhappiness as registered by the SF-36. According to the patient-oriented outcomes tool, 31% of late results are ＂unsatisfactory＂.

关 键 词：疗效 胫骨髓内钉 评分 

分 类 号：R687.33[医药卫生—骨科学]