弹性髓内钉内固定与钢板内固定治疗儿童四肢长骨骨折的比较研究  

A comparative study of internal fixation with elastic intramedullary nail versus steel plate for treatment of long bone fractures of limbs in children

作　　者：屈继宁[1] 张银刚[1] 袁启令 刘亮[1] 

机构地区：[1]西安交通大学第一附属医院,陕西西安710061

出　　处：《中医正骨》2017年第2期6-10,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：国家自然科学基金项目(81371987)

摘　　要：目的:比较弹性髓内钉内固定与钢板内固定治疗儿童四肢长骨骨折的临床疗效和安全性。方法:将100例四肢长骨骨折患儿随机分为2组,其中采用弹性髓内钉内固定术50例,采用钢板内固定术50例。男77例,女23例。年龄3~14岁,中位数9岁。上肢骨折58例,下肢骨折42例;螺旋形骨折20例,斜形骨折41例,横形骨折39例。比较2组患儿手术时间、术中出血量、住院时间、骨折愈合时间及并发症发生情况,并于术后6个月比较2组患儿的临床疗效。结果:2组患儿手术时间比较差异无统计学意义[(40.60±8.50)min,(48.00±9.33)min,t=3.230,P=0.430];弹性髓内钉组术中出血量小于钢板内固定组[(50.60±18.35)mL,(165.30±35.80)mL,t=6.674,P=0.000],住院时间和骨折愈合时间短于钢板内固定组[(6.50±2.75)d,(14.75±4.40)d,t=5.785,P=0.000;(55.62±7.55)d,(80.30±8.96)d,t=4.477,P=0.034]。术后6个月,参照《常见疾病的诊断与疗效判定(标准)》中肢体关节功能评价标准评价临床疗效,弹性髓内钉组优40例、良9例、可1例,钢板内固定组优36例、良12例、可2例;2组患儿临床疗效比较差异无统计学意义(Z=-0.956,P=0.339)。2组患儿骨折断端对位对线均良好,均无骨折不愈合或延迟愈合、钉道感染、骨髓炎等并发症发生。结论:对于四肢长骨骨折患儿而言,弹性髓内钉内固定与钢板内固定在临床疗效、安全性方面比较无明显差异,但前者较后者能够减轻创伤、减少出血量、缩短住院时间和骨折愈合时间,值得临床推广应用。Objective：To compare the clinical curative effect and safety of internal fixation with elastic intramedullary nail versus steel plate in the treatment of long bone fractures of limbs in children.Methods：One hundred children with long bone fractures of limbs were randomly divided into 2 groups.Fifty children were treated with elastic intramedullary nail internal fixation（group A）,while the others were treated with steel plate internal fixation（group B）.The children consisted of 77 males and 23 females,and ranged in age from 3 to 14 years（Median = 9 yrs）.The fractures located in upper limb for 58 children and lower limb for 42 children.The fractures belonged to spiral fractures（20）,oblique fractures（41） and transverse fractures（39）.The operative time,blood loss,hospital stay fracture healing time and complications were recorded and compared between the 2 groups,and the clinical curative effect were also compared between the 2 groups at 6months after surgery.Results：There was no statistical differencs in the operative time between the two groups（40.60 ＋/- 8.50 vs48.00 ＋/-9.33 min,t =3.230 P = 0.430）.The blood loss were less in group A compared to group B（50.60 ＋/- 18.35 vs 165.30 ＋/-35.80 ml p =6.614,P =0.000）.The hospital stays and fracture healing time were shorter in group A compared to group B（6.50 ＋/-2.75 vs 14.75 ＋/-4.40 days,t=5.785,P =0.000;55.62＋/-1.55 vs 80.30 ＋/-8.96 days,t =4.477 P = 0.034）.At 6 months after surgery,the clinical curative effects were evaluated according to the therapeutic effect standard of limb and joint function extracted from Standard for diagnosis and curative effect evaluation of common diseases.Forty children obtained an excellent result,9 good and 1 fair in the group A;while 36 children obtained an excellent result,12 good and 2 fair in the group B.There were no statistical differences in the clinical curative effects between the two groups（Z =-0.956 P =0.339）.Satisfactory paratope and alignment of fractures were obtain

关 键 词：骨折 四肢 骨干 儿童 骨折固定术 内 弹性髓内钉 钢板 临床试验 

分 类 号：R726.8[医药卫生—儿科]