弹性髓内钉与锁定钢板内固定在四肢骨干骨折中临床应用研究  

Clinical application of elastic in tramedullary nail and locking plate internal fixation in treating bone shaft fracture of limbs

作　　者：马胜东 杨晓茂 杨洪军[1] 冯浩[1] 肖军[1] 李治国[1] MA Sheng-dong;YANG Xiao-mao;YANG Hong-jun;FENG Hao;XIAO Jun;LI Zhi-guo(Department of Orthopedics,People's Hospital of Ya'an City,Ya'an,Sichuan 625000,China)

机构地区：[1]雅安市人民医院骨科,四川雅安625000

出　　处：《创伤外科杂志》2020年第4期298-301,共4页Journal of Traumatic Surgery

摘　　要：目的探讨弹性髓内钉与锁定钢板内固定对四肢骨干骨折中的影响,为临床治疗四肢骨干骨折提供有效依据。方法前瞻性研究2016年4月—2017年6月四川省雅安市人民医院治疗的四肢骨干骨折患者98例,男性55例,女性43例;年龄20~59岁,平均36.6岁。按照随机数表法分为弹性髓内钉组(50例)和锁定钢板组(48例),弹性髓内钉组行弹性髓内钉内固定处理;锁定钢板组行锁定钢板内固定。比较两组患者围术期指标(手术时间、住院时间、骨折愈合时间、骨折线消失时间、术中出血量)、治疗前后VAS评分、愈合情况及并发症发生情况。结果弹性髓内钉组手术时间、住院时间、骨折愈合时间、骨折线消失时间均显著短于锁定钢板组(77.04±12.67)min vs.(117.76±17.64)min、(6.56±1.12)d vs.(7.93±1.27)d、(14.19±1.67)周vs.(17.42±1.98)周、(16.89±2.24)周vs.(19.45±2.64)周,P<0.05;弹性髓内钉组术中出血量显著少于锁定钢板组(98.67±12.74)mL vs.(211.84±23.48)mL,差异有统计学意义(P<0.001)。术前两组患者VAS评分比较差异无统计学意义(P=0.862),术后2、4周弹性髓内钉组VAS评分(4.34±0.36)分、(3.65±0.34)分显著低于锁定钢板组(5.17±0.49)分、(4.68±0.55)分,差异有统计学意义(P<0.01)。弹性髓内钉组愈合率96.00%显著高于锁定钢板组81.25%(P=0.006);弹性髓内钉组优良率90.00%显著高于锁定钢板组64.58%(P=0.003)。两组患者并发症发生率分别为10.00%与18.75%,差异无统计学意义(P=0.117)。结论弹性髓内钉内固定治疗四肢骨干骨折效果显著,且其能显著加速患者康复,改善预后,值得临床推广使用。Objective To explore the effect of elastic intramedullary nail and locking plate internal fixation on the rehabilitation of limb diaphyseal fracture,and to provide an effective basis for clinical treatment of limb diaphyseal fracture.Methods From Apr.2016 to Jun.2017,98 patients with limb shaft fracture who were treated in Ya'an people's Hospital of Sichuan Province were selected for prospective study.There were 55 males and 43 females,aged 20-59 years with an average age of 36.6 years.They were randomly divided into two groups:elastic intramedullary nail group and locking plate group.There were 50 patients in the elastic intramedullary nail group,who were treated with internal fixation of elastic intramedullary nail.In the fixed plate group were 48 patients treated with locking plate fixation.The perioperative indexes(operation time,hospitalization time,fracture healing time,fracture line disappearance time,intraoperative bleeding volume),VAS score before and after treatment,healing and complications were compared between the two groups.Results The operation time,hospitalization time,fracture healing time and fracture line disappearance time in the elastic intramedullary nail group were significantly shorter than those in the locking plate group[(77.04±12.67)mm vs.(117.76±17.64)min,(6.56±1.12)d vs.(7.93±1.27)d,(14.19±1.67)weeks vs.(17.42±1.98)weeks,(16.89±2.24)weeks vs.(19.45±2.64)weeks](P<0.001);the amount of bleeding in the elastic intramedullary nail group was significantly less than that in the locking plate group[(98.67±12.74)mL vs.(211.84±23.48)mL],and the difference between the two groups was significant(P<0.01).There was no significant difference in VAS score between the two groups before treatment(P=0.862).The VAS score of elastic intramedullary nail group was(4.34±0.36)points and(3.65±0.34)points at 2 and 4 weeks after operation,significantly lower than those of locking plate group[(5.17±0.49)points,(4.68±0.55)points],and the differences were statistically significant(P<0.05).The healing

关 键 词：四肢骨干骨折 髓内钉 锁定钢板 内固定 

分 类 号：R687.3[医药卫生—骨科学]