江西钢板与髓内钉治疗股骨干骨折的多中心研究  

Femoral shaft fractures treated by intramedullary nail and plate osteosynthesis： a multi-center study in Jiangxi Province

作　　者：廖琦[1] 郝亮[1] 张国华 仇志强[1] 范少勇[1] 黄陈翼[1] 

机构地区：[1]南昌大学第二附属医院骨二科,330006 [2]南昌市新建县人民医院骨科

出　　处：《中华创伤骨科杂志》2012年第7期582-586,共5页Chinese Journal of Orthopaedic Trauma

基　　金：江两省卫生厅科技计划项目（20083051）

摘　　要：目的探讨钢板与髓内钉两种内吲定方式在江西省的应用现状与疗效差异。方法回顾性分析江西省5家三甲医院于2007年1月至2009年12月收治且获得随访的390例（410侧）股骨干骨折患者资料，按照内固定治疗方式不同分为两组：钢板组（采用钢板治疗股骨十骨折）257例（271侧），男197例，女60例；髓内钉组（采用随内钉治疗股骨于骨折）133例（139侧），舛108例，女25例。记录并比较两组患者的手术时间、术中出血量、术后住院时间、恢复下地时间、术后并发症发生情况及末次随访时Karlstrtim—Olerud疗效评定结果。结果髓内钉组手术时间【（149．2±27．9）minl较钢板组【（120．2±28．1）min】长，术中出血最【（459．7±108．8）mL]较钢板组[（429．9±113．7）mL）多，差异均有统计学意义（P〈0．05）。两组患者术后住院时间I（13．7±5．2）dm（14．1±5．6）d】和恢复下地时间r（3．5±0．9）个月w．（3．7±0．9）个月】比较差异均无统计学意义（P〉0．05）．，两组患者术后总的并发症发生率（43／257m15／133）、未次随访时Kal-lstz·bIll-Olerud疗效评定优良率（232／257㈨125／133）差异均无统计学意义（P〉0．05），但钢板组内同定断裂发生率（17／257）明冠高于髓内钉组（1／133）[OR=9．24，95％CI（1．22，70．14），P=0．03]。结论钢板和髓内钉治疗股骨干骨折均叮取得满意效果，但江西省髓内钉的使用牢和使用效果明显低于国际及国内水平。Objective To compare the clinical outcomes of intramedullary nail versus plate os- teosynthesis for the treatment of femoral shaft fi＇actures in the aduh patients in Jiangxi Province, China. Methods A retrospective investigation was conducted to review the 390 patients with femoral shaft fracture （410 sides） who had been treated fi＇om January 2007 to December 2009 and completely followed up in 5 major hospitals in Jiangxi Province, China. In the plate osteosynthesis group, there were 257 cases （271 sides）, 197 men and 60 women. In the intramedullary nail osteosynthesis group, there were 133 cases （139 sides）, 108 men and 25 women. The 2 groups were compared in terms of operation time, surgical bleeding, post- operative hospital stay, ambulant time, postoperative complications and Karlsh＇6m-Olerud score at the last fol- low-up. Results The nail group had significantly longer operation time （ 149.2 minutes 27.9 minutes rs. 120.2 minutes ± 28. 1 minutes） and significantly more surgical bleeding （459.7 mL± 108.8 mL vs. 429.9 mL± 13.7 ml,） than the plate group （ P 〈 0.05）. There were no significantly differences regarding hospitalization time [（13.7±5.2） d vs. （14. 1 ±5.6） d], ambulant time[（3.5 ±0.9） months vs. （3.7 ±0.9） months], complica- tions （43/257 vs. 15/133） or Karlstrthn-Olerud score （232/257 vs. 125/133） between the 2 groups （ P 〉 0.05 ）. but the failure of internal fixation in the plate group （17/257） was significantly higher than in the nail group （1/133） [ OR =9, 24, 95% CI（ 1.22, 70. 14）, P =0.03]. Conclusions Our study reveals that the outcomes of intramedullaly nail and plate osteosynthesis are both satisfaetol）,, but the intramedullamedull ail os- teosvnthesis is used much less and yields less satisfactory outcomes in treatment of femoral shaft fracture in Jiangxi Province than in the advanced hnspitals in other regions of China and the world.

关 键 词：股骨骨折 骨折固定术 内 骨板 骨钉 

分 类 号：R687.3[医药卫生—骨科学]