弹性髓内钉固定与石膏外固定治疗儿童胫骨干闭合性骨折的疗效分析  

Therapeutic effect of elastic intramedullary nail fixation and external fixation of gypsum on tibial shaft closed fracture in children

作　　者：蒋鹏[1] 王强 JIANG Peng;WANG Qiang(Wannan Medical College,Wuhu 241000,China)

机构地区：[1]皖南医学院,安徽芜湖241000 [2]皖南医学院第一附属医院关节骨科,安徽芜湖241000

出　　处：《华北理工大学学报（医学版）》2018年第2期102-106,共5页Journal of North China University of Science and Technology：Health Sciences Edition

摘　　要：(1)目的对比分析弹性髓内钉与石膏外固定治疗儿童闭合性胫骨干骨折的临床疗效。(2)方法选取我院32例闭合性胫骨干骨折儿童患者,随机分为手术组(13例)和保守治疗组(19例)。手术组采用弹性髓内钉闭合复位方法手术治疗,保守治疗组采用手法复位加石膏外固定方法治疗,32例患者术后均获得7个月以上随访。对比两组治疗后疼痛评分、并发症、功能恢复情况等。(3)结果所有患者随访6~14个月,平均10个月。根据Flynn评价标准,手术组优10例,良2例,差1例,优良率达到92.3%;1例出现断端侧方成角大于15°,1例出现皮肤激惹现象。保守治疗组优9例,良6例,差4例,优良率为78.9%;2例出现压疮,1例出现张力性水泡,2例复查过程中出现骨折断端侧方成角大于18°,1例出现骨折断端旋转,1例出现前后成角大于25°,单纯石膏外固定失败改行手术治疗,差异有统计学意义(P<0.05)。根据视觉模拟评分法(VAS)评分,比较两组术前与术后的疼痛,手术组术后疼痛评分较保守治疗组明显降低,差异有统计学意义(P<0.05),有益于患者早期活动、功能锻炼。(4)结论保守治疗组治疗闭合性胫骨干骨折,由于患儿依从性、耐受性较差,不利于患者的功能锻炼及治疗。手术组治疗儿童闭合性胫骨干骨折,具有方法简便、软组织剥离少,手术风险小的优点,固定可靠,有利于早期锻炼,是治疗儿童闭合性胫骨干骨折的理想方法。Objective To compare the clinical effect of elastic intramedullary nail and external fixation for the treatment of closed tibial fractures in children.Methods A total of 32 children with closed tibial fracture in our hospital were randomly divided into surgery group(n=13)and conservative group(n=19).The operation group was treated with closed reduction with elastic intramedullary nail,and the conservative group was treated with manual reduction and plaster cast external fixation.All the patients were followed up for more than 7 months after the operation.The pain scores,complications and functional recovery were compared between the two groups after treatment.Results All patients were followed up for 6~14 months with an average of 10 months.According to the flynn evaluation standard,the surgery group was excellent in 10 cases,good in 2 cases and poor in 1 cases,and the excellent rate reached 92.3%.There was 1 cases with skin irritation,In 1 cases,the lateral angle of broken end was more than 15°.The conservative group was excellent in 9 cases,good in 6 cases and poor in 4 cases,the excellent rate reached 78.9%.2 patients had pressure sores,1 case of tension blister.In the 2 patients,the fracture occurred at the end of fracture,and the lateral angulation was greater than 18°,1 patient showed fracture end rotation,In 1 case,the fracture angle was greater than 25°before and after fracture.The plaster external fixation failed and underwent surgical treatment,the difference was statistically significant(P<0.05).According to the VAS score,the preoperative and postoperative pain of the two groups were compared.The postoperative pain of the elastic intramedullary nail group was significantly lower than that of the plaster external fixation group,which was beneficial to the early functional exercise and activity of the patients,and the difference was statistically significant(P<0.05).Conclusion The treatment of tibial shaft fracture with external fixation is not conducive to the treatment and functional exercise of chi

关 键 词：胫骨干骨折 弹性髓内钉 生物学固定 儿童 

分 类 号：R683[医药卫生—骨科学]