微创钢板接骨技术联合锁定加压钢板内固定对四肢粉碎性骨折患者术后骨折愈合及血清神经生长因子、血管细胞黏附分子及碱性磷酸酶水平的影响  

Effect of minimally invasive plate osteosynthesis combined with locking compression plate fixation on postoperativefracture healing and serum levels of nerve growth factor, vascular cell adhesion molecule and alkaline phosphatase in patients with limb comminuted fracture

作　　者：万马 徐苏洋[1] 高田田[1] Wan Ma;Xu Suyang;Gao Tiantian.(Orthopaedics Department, the Eighth People＇s Hospital of Shanghai, Xuhui Branch of the Sixth People＇s Hospital of Shanghai, Shanghai 200237, Chin)

机构地区：[1]上海市第八人民医院上海市第六人民医院徐汇分院骨科,200237

出　　处：《中国综合临床》2018年第3期253-257,共5页Clinical Medicine of China

摘　　要：目的探讨微创钢板接骨技术联合锁定加压钢板内固定对四肢粉碎性骨折患者术后骨折愈合及血清神经生长因子、血管细胞黏附分子及碱性磷酸酶水平的影响。方法选取2014年1月至2016年5月我院74例四肢粉碎性骨折患者，随机数字表法分为对照组（n＝37）与研究组（n＝37）。对照组采用传统切开复位内固定术，研究组采用锁定加压钢板内固定联合微创钢板接骨技术，术后1～4个月进行随访。统计对比两组临床疗效、围术期指标（手术用时、术中失血量、骨折愈合时间）情况、入院时及术后第1天血清因子（神经生长因子、血管细胞黏附分子、碱性磷酸酶）水平变化情况、并发症发生率。 结果两组治疗总有效率比较，研究组97.30%（36/37）较对照组78.38%（29/37）高，差异有统计学意义（χ2＝4.554，P〈0.05）；研究组手术用时（84.76±11.08） min较对照组（71.89±10.54） min长，术中失血量（108.52±21.33） ml较对照组（245.30±24.61） ml少，骨折愈合时间（9.04±1.81）周较对照组（12.79±2.02）周短，差异有统计学意义（t分别为5.119、25.547、8.410，P均〈0.05）；术后两组血清神经生长因子、血管细胞黏附因子、碱性磷酸酶水平较术前增高，且研究组血清神经生长因子（1.33±0.19）ng/L、碱性磷酸酶（312.04±31.07）U/L较对照组[（0.85±0.22） ng/L、（181.28±30.45）U/L]高，血清血管细胞黏附因子（502.18±40.07） μg/L水平较对照组（579.28±41.15） μg/L低，差异有统计学意义（t值分别为10.044、18.283、8.165，P均〈0.05）；两组并发症发生率比较，研究组8.11%（3/37）较对照组27.03%（10/37）低，差异有统计学意义（χ2＝4.573，P〈0.05）。结论锁定加压钢板内固定联合微创钢板接骨技术治疗四肢粉碎性骨折，可缩短骨折愈合时间，提高治疗效果，改善血清NGF、s VCAM、ALP水平，且并发症发生�Objective To investigate the effect of minimally invasive plate osteosynthesis combined with locking compression plate fixation on postoperative fracture healing and serum levels of and serum nerve growth factor （NGF）, vascular cell adhesion molecule （s VCAM）, alkaline phosphatase （ALP） in patients with limb comminuted fracture.MethodsFrom January 2014 to May 2016, seventy-four patients with limb comminuted fracture in the Eighth People＇s Hospital of Shanghai were enrolled in this study and randomly divided into the control group （37 cases） and the study group （37 cases）. The traditional incision and reduction fixation were used in the control group.The study group was treated with locking compression plate internal fixation combined with minimally invasive plate bone grafting technique.The patients were followed up for 1~ 4 months after operation.The clinical efficacy, perioperative indicators （operation time, intraoperative blood loss, fracture healing time）, serum （nerve growth factor, vascular cell adhesion molecule, alkaline phosphatase） levels change at the time of admission and after first D and complications rate were statistically compared.ResultsThe total effective rate of the study group was 97.30% （36/37）, higher than that in the control group （78.38% （29/37））, and the difference was statistically significant（χ2=4.554, P〈0.05）. The operation time of the study group was （84.76 ±11.08） min, longer than that of the control group （（71.89±10.54） min）, the intraoperative blood loss of the study group （（108.52 ± 21.33） ml）was less than that of the control group （（245.30±24.61） ml）, and the fracture healing time of the study group （（9.04 ± 1.81） weeks）was shorter than that of the control group （（12.79±2.02） weeks）, and the difference was statistically significant （t=5.119, t=25.547, t=8.410, P〈0.05）. The levels of serum NGF, s VCAM and ALP in the two groups after operation were higher than those before ope

关 键 词：微创钢板接骨技术 锁定加压钢板内固定 四肢粉碎性骨折 骨折愈合 血清 因子 

分 类 号：R687.3[医药卫生—骨科学]