旋入式自锁髓内钉与交锁髓内钉治疗胫骨骨折  

Rotated self-locking intramedullary nail and interlocking intramedullary nailing in the treatment of tibial fractures

作　　者：张仲子[1] 赵烽[1] 张武[1] 任云峰[1] 熊鹰[1] 

机构地区：[1]昆明医科大学附属延安医院骨科,云南昆明650051

出　　处：《临床骨科杂志》2014年第2期178-182,共5页Journal of Clinical Orthopaedics

摘　　要：摘要：目的对比分析旋入式自锁髓内钉与交锁髓内钉治疗胫骨骨折的临床疗效。方法将247例胫骨骨折患者按手术方式不同分为旋入式自锁髓内钉组（旋入钉组，180例）和交锁髓内钉组（交锁钉组，67例）。记录手术时间、术中透视时间、失血量、闭合复位率、下地负重时间、骨折愈合时间及相关并发症，并进行分析；两组患者肢体功能参照Johner—Wruhs标准进行评估。结果247例均获随访，时间12～60个月。手术时间：旋入钉组（504-30）rain，交锁钉组（80±20）min；术中透视时间：旋入钉组（4±2．8）s，交锁钉组（20±10）8；下地负重时间：旋入钉组（7±4．6）d，交锁钉组（14±7．0）d；骨折愈合时间：旋入钉组（16±4．3）周，交锁钉组（20±5．5）周；以上各项指标的时间旋入钉组均短于交锁钉组（P〈0．05）。失血量i旋入钉组（60±33）ml，交锁钉组（65±27）m1，两组差异无统计学意义（P〉0．05）。闭合复位率：旋入钉组50．6％（91／180），交锁钉组62．7％（42／67），交锁钉组高于旋入钉组（P〈0．05）。骨折愈合率：旋入钉组100％，交锁钉组97％（其中15例拆除远端锁钉动力化后骨折愈合），两组差异无统计学意义（P〉0．05）。并发症：旋入钉组感染6例、锁片退出2例、交锁钉组感染4例、内固定折断2例。再手术率：旋入钉组为1．1％，交锁钉组25．4％，旋入钉组低于交锁钉组（P〈0．05）。功能评价：旋入钉组肢体功能优良率98％，交锁钉优良率95％，两组差异无统计学意义（P〉0．05）。结论旋入式自锁髓内钉与交锁髓内钉治疗胫骨简单骨折均能获得良好的临床效果。但旋入式自锁髓内钉操作简单，可明显缩短手术时间，减少术中透视，有利于下肢早期负重锻炼，促进骨折愈合。Objective To compare clinical efficacy of rotated self-locking intramedullary nail and interlocking intr- amedullary nail in the treatment of tibial fractures. Methods 247 patients of simple tibial fractures were divided into two groups according to the different internal flxator： rotated self- locking intramedullary nail group（ 180 cases） and interlocking intramedullary nail group（67 cases）. Operative time, intraoperative fluoroscopy time, blood loss, closed reduction rate, weight-beating ambulation time and healing time and the complications were analyzed , and the limb function were evaluated according to the standard of Johner-Wruhs. Results All the 247 cases were followed up for 12 to 60 months. The operation time of rotated self-locking intramedullary nail group and interlocking intramedullary nail group were （50 ± 30） rain and （80±20） rain; Fluoroscopy time of rotated self-locking intramedullary nail group and interlocking intramedullary nail group were （4 ±2. 8） s and （20 ±10） s; Fracture healing time： rotated self-loc- king intramedullary nail group and interlocking intramedullary nail group were （16 ±4. 3 ） weeks and （20 ± 5.5 ） weeks; Ambulation load time of two groups were： （7 ±4. 6） d and （ 14 ±7.0） d. In time of respect above, rotated self-locking intramedullary nail group was shorter compared with the interlocking nail group （P 〈 0.05 ）. Closed re- duction rate： rotated self-locking intramedullary nail group was 50. 6% （91/180）, and interlocking intramedullary nail group was 62. 7% （42/67） ,P 〈 0. 05. Blood loss of rotated self-locking intramedullary nail group and interloc- king intramedullary nail group were （60± 33） ml and （65± 27 ） ml, P 〉 0. 05. Fracture healing rate ： rotated self- locking intramedullary nail group was 100% and 97% of the interlocking intramedullary nail group（ 15 cases of frac- ture finally healed after dynamization by removing the distal locking screw）. The difference was not statistic

关 键 词：胫骨骨折 旋入式自锁髓内钉 交锁髓内钉 

分 类 号：R683.42[医药卫生—骨科学] R687.33[医药卫生—外科学]