交锁髓内钉内固定治疗胫骨干骨折的临床研究  

Clinical study on the internal fixation with interlocking intramedullary nail for the treatment of tibial shaft fractures

作　　者：葛波涌[1] 王玉波[1] 王明太[1] 杨颖[1] 周鹿安[1] 刘郑和[1] 

机构地区：[1]郑州大学第二附属医院,河南郑州450003

出　　处：《中医正骨》2015年第10期8-10,14,共4页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的：观察交锁髓内钉内固定治疗胫骨干骨折的临床疗效和安全性。方法：将符合要求的80例胫骨干骨折患者随机分为2组,每组40例,分别采用交锁髓内钉和外固定架固定治疗。术后比较2组患者的骨痂出现时间、骨折愈合时间、临床疗效及并发症发生率,临床疗效评定采用Johner-Wruhs胫骨干骨折疗效标准。结果：所有患者均获随访,随访时间7-25个月,中位数10个月。交锁髓内钉组骨痂出现时间和骨折愈合时间均短于外固定架组[（38.1±4.2）d,（53.4±5.1）d,t=7.398,P=0.013;（136.1±10.0）d,（193.5±8.3）d,t=8.654,P=0.011];末次随访时按照Johner-Wruhs胫骨干骨折疗效标准评定,交锁髓内钉组优20例、良9例、可9例、差2例,外固定架组优12例、良9例、可15例、差4例,交锁髓内钉组的临床疗效优于外固定架组（R交锁髓内钉组=35.52,R外固定架组=45.48,Z=-2.021,P=0.043）。至随访结束时,交锁髓内钉组2例发生切口感染、1例发生骨折延迟愈合、1例发生断钉,外固定架组6例发生切口感染、4例发生骨折延迟愈合;2组患者的并发症发生率比较,差异无统计学意义（χ^2=3.117,P=0.077）。结论：采用交锁髓内钉内固定治疗胫骨干骨折,骨折愈合快、疗效确定、安全性高,值得临床推广应用。Objective： To observe the clinical curative effects and safety of internal fixation with interlocking intramedullary nail for the treatment of tibial shaft fractures. Methods： Eighty patients with tibial shaft fractures enrolled in the study were randomly divided into 2groups,40 cases in each group,and the patients were treated with interlocking intramedullary nail internal fixation（ group A） and frame external fixation（ group B） respectively. The occurrence time of bony callus,fracture healing time,clinical curative effects and complication incidences were compared between the 2 groups after the operation,and the clinical curative effects were evaluated by using Johner- Wruhs standard for therapeutic effectiveness evaluation of tibial shaft fractures. Results： The patients in the 2 groups were followed up for 7- 25 months with a median of 10 months. The occurrence time of bony callus and fracture healing time were shorter in group A compared to group B（ 38. 1 ＋ /- 4. 2 vs 53. 4 ＋ /- 5. 1 days,t = 7. 398,P = 0. 013; 136. 1 ＋ /- 10. 0 vs 193. 5 ＋ /- 8. 3 days,t = 8. 654,P = 0. 011）. Twenty patients obtained an excellent result,9 good,9 fair and 2 poor in group A; while 12 patients obtained an excellent result,9 good,15 fair and 4poor in group B according to Johner- Wruhs standard for therapeutic effectiveness evaluation of tibial shaft fractures at last follow- up. The group A surpassed the group B in the total curative effects（ Rgroup A= 35. 52,Rgroup B= 45. 48,Z =- 2. 021,P = 0. 043）. The incision infection（ 2 patients）,delayed union of fracture（ 1 patient） and breakage of nail（ 1 patient） were found in group A; while incision infection（ 6 patients） and delayed union of fracture（ 4 patients） were found in group B during the follow- up period. There was no statistical differences in the rate of complications between the 2 groups（ χ^2= 3. 117,P = 0. 077）. Conclusion： Interlocking intramedullary nail internal fixation has such advantages as short fracture hea

关 键 词：胫骨骨折 骨折固定术 髓内 治疗 临床研究性 

分 类 号：R687.3[医药卫生—骨科学]