损伤早期与延期带锁髓内钉结合钢板治疗胫骨AO/ASIF-42C2型多段骨折的病例对照研究  

Comparison of effect between early and delayed in primary intramedullary nailing combined with locked plate fixation for the treatment of multi-segments tibial fractures of type AO/ASIF-42C2

作　　者：高伟强[1] 胡江海[1] 顾祖超[1] 张怀先[1] 闵鹏[1] 张林军[1] 余雯雯[2] 王光林[2] 

机构地区：[1]成都市第一人民医院骨科,四川成都610041 [2]四川大学华西医院,四川成都610000

出　　处：《中国骨伤》2015年第2期122-125,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的 ：比较损伤早期与延期带锁髓内钉结合钢板治疗AO/ASIF-42C2型胫骨多段骨折的临床效果。方法：2010年1月至2013年1月,采用带锁髓内钉结合钢板治疗闭合性AO/ASIF-42C2型胫骨多段骨折45例患者,根据手术时机,将患者分为两组,早期组20例,早期接受带锁髓内钉结合钢板手术,男13例,女7例,年龄20-56岁,平均（37.9±14.3）岁;按照Tscherne软组织损伤分型：Ⅰ级8例,Ⅱ级12例。延期组25例,延期接受带锁髓内钉结合钢板手术,男17例,女8例;年龄24-55岁,平均（38.7±17.2）岁;其中TscherneⅠ级4例,Ⅱ级19例,Ⅲ级2例。记录两组的手术时间,术中出血量,住院时间,骨折愈合时间及并发症等。末次随访中采用Johner-Wruhs标准评价患者的功能疗效,采用正侧位X线片评估骨折复位维持及对线情况。结果：所有患者术后获得随访,早期组与延期组的平均随访时间分别为（12.5±2.5）个月和（13.2±2.8）个月,组间差异无统计学意义（P〉0.05）。两组术后未发生伤口感染等软组织并发症,末次随访患者膝关节平均活动度10°-0°-120°。按照Johner-Wruhs评价疗效：早期组优15例,良3例,可2例;延期组优21例,良2例,可2例。两组的平均手术时间、术中出血量差异无统计学意义（P〉0.05）,但早期组的住院时间显著短于延期组（P〈0.05）。早期组与延期组的平均骨折愈合时间分别为（5.3±2.6）个月和（6.0±2.9）个月,组间差异无统计学意义（P〉0.05）。结论：对于术前软组织损伤较轻的TscherneⅠ、Ⅱ级AO/ASIF-42C2型胫骨多段骨折,早期行带锁髓内钉结合钢板治疗并不会增加患者的术后软组织并发症发生率,可实现与延期相当的临床效果。Objective：To compare the clinical results of early and delayed intramedullary nailing and locked plating for the treatment of multi segments tibial fractures of type AO / ASIF-42C2. Methods：Between January 2010 and January2013,45 patients with multi segments closed tibial fractures of AO / ASIF-42C2 were treated by early primary intramedullary nailing and locked plating in 20 cases as early group and delayed in 25 cases as delayed group. In early group,20 cases included 13 males and 7 females with an average age of（37.9±14.3） years old ranging from 20 to 56 years;according to soft tissue injury Tscherne classification,8 fractures were frade I,12 were gradeⅡ. In delayed group,25 cases included 17 males and8 females with an average age of（38.7±17.2） years old ranging from 24 to 55 years,4 fractures were gradeⅠ,19 were gradeⅡ,2 were grade Ⅲ. The operative time,blood loss,hospital stay,fracture healing time and complications were recorded. At final follow up,the Johner-Wruhs score were used to evaluate functional efficacy,and the posterior anterior and lateral X ray to evaluate fracture reduction and alignment. Results：All the patients were followed up for（12.5±2.5） months in early group and（13.2±2.8） months in delayed group（P〉0.05）. No wounds infections were happened. At the last follow up,the mean range of knee joint was 10°-0°-120°. According to Johner-Wruhs scoring,there were 15 cases in excellent,3 in good,fair in 2 in early group; 21 in excellent,2 in good,2 in fair. The average operative time,blood loss had no significant differences between two groups（P〉0.05）,but hospital stay in early group was significantly shorter than those in delayed group（P〈0.05）. Average fracture healing time of early group and delayed group were（5.3±2.6） months and（6.0±2.9） months,respectively（P〉0.05）.Conclusion：For multi segments tibial fractures of type AO / ASIF-42C2 with preoperative minor soft tissue injuries lighter of Tscherne gradeⅠorⅡ,early primary i

关 键 词：胫骨骨折 骨折固定术 髓内 骨折固定术 内 外科手术 病例对照试验 

分 类 号：R683.42[医药卫生—骨科学]