更换髓内钉与保留髓内钉附加钢板治疗髓内钉固定后股骨肥大性骨不连  

Nailing Exchange and Retaining Intramedullary Nail with Additional Plate in Treatment of Femur Hypertrophic Femoral Nonunion after the Intramedullary Nail Fixation

作　　者：王华[1] 陈波[1] 乐锦波[1] 谭虎成 WANG Hua;CHEN Bo;LE Jin-bo;TAN Hu-cheng(Department of Orthopedics,People's Hospital of China Three Gorges University(Yichang First People’s Hospital),Yichang,Hubei Province,443003 China)

机构地区：[1]三峡大学人民医院(宜昌市第一人民医院)骨科,湖北宜昌443003

出　　处：《中外医疗》2018年第8期73-75,78,共4页China & Foreign Medical Treatment

摘　　要：目的探讨对髓内钉固定后股骨肥大性骨不连患者给予更换髓内钉以及保留髓内钉附加钢板治疗的临床效果。方法方便抽取2016年7月—2017年6月该院所接收的28例髓内钉固定后股骨肥大性骨不连患者,随机分为两组进行研究,按照所采取的治疗方法不同分为保留组和更换组,每组患者分别为14例。更换组行更换髓内钉治疗,保留组则行保留髓内钉附加钢板治疗,观察并比较两组再手术率、临床指标的变化情况以及住院费用。结果保留组的手术时间(85.7±33.5)min,更换组为(99.6±53.4)min,(t=0.825,P=0.417),保留组的术中出血量(239.2±115.4)m L,更换组为(212.6±155.6)m L,(t=0.514,P=0.612),保留组引流血量(197.3±102.3)m L,更换组为(148.6±68.8)m L,(t=1.478,P=0.151),组间相比均差异无统计学意义(P>0.05)。保留组的再手术率0例(0.00%)显著低于更换组4例(28.57%),(χ~2=4.667,P=0.031);保留组的住院费用(20 252.2±1 173.1)元显著低于更换组(11 015.2±1 310.8)元,差异有统计学意义(t=19.648,P=0.000)。结论对于股骨狭部肥大性骨不连患者给予更换髓内钉治疗,能够获取十分有效的治疗效果。但是对于伴有大蝶型游离骨块、干骺端骨不连、骨缺损以及更换髓内钉治疗失败的患者而言,则需要采取保留髓内钉附加钢板的治疗方法,疗效十分确切、肯定。Objective To study the clinical effect of nailing exchange and retaining intramedullary nail with additional plate in treatment of femur hypertrophic femoral nonunion after the intramedullary nail fixation.Methods 28 case of patients with femur hypertrophic femoral nonunion after the intramedullary nail fixation admitted and treated in our hospital from July 2016 to June 2017 were convenient selected for research and divided into two groups with 14 cases in each,the exchange group and the retaining group were respectively treated with nailing exchange and retaining intramedullary nail with additional plate,and the reoperation rate,changes of clinical indicators and hospitalization cost of the two groups were observed and compared.Results The operation time in the retaining group and in the exchange group was respectively(85.7±33.5)min and(99.6±53.4)min,(t=0.825,P=0.417),and the intraoperative bleeding amount in the retaining group and in the exchange group was respectively(239.2±115.4)mL and(212.6±155.6)mL,(t=0.514,P=0.612),and the drainage blood volume in the retaining group and in the exchange group was respectively(197.3±102.3)mL and(148.6±68.8)mL,(t=1.478,P=0.151),and the difference was not obvious(P>0.05),and the reoperation rate in the retaining group was obviously lower than that in the exchange group,(0.00%vs 28.57%,0 case vs 4 cases)(χ2=4.667,P=0.031),and the hospitalization cost in the retaining group was obviously lower than that in the exchange group[(20 252.2±1 173.1)yuan vs(11 015.2±1 310.8)yuan],and the difference was statistically significant(t=19.648,P=0.000).Conclusion The effect of nailing exchange in treatment of femur hypertrophic femoral nonunion after the intramedullary nail fixation is very effective,and for patients with large butterflies free bone,metaphyseal nonunion,bone defects and failure to replace the intramedullary nail,the retaining intramedullary nail with additional plate is necessary,and the curative effect is very definite and positive.

关 键 词：更换髓内钉 保留髓内钉附加钢板治疗 髓内钉固定后股骨肥大性骨不连 

分 类 号：R687[医药卫生—骨科学]