高压氧辅助微创钢板内固定术治疗胫骨中下段骨折的疗效及对血运的影响  

Curative effect and influence on blood supply of hyperbaric oxygen assisting minimally invasive plate osteosynthesis in treating the middle and distal tibia fracture

作　　者：周振东[1] 董宝铁[1] 费良健[1] 牛续光 李子龙 李泓[1] Zhou Zhendong;Dong Baotie;Fei Liangjian;Niu Xuguang;Li Zilong;Li Hong(First Department of Orthopedics,The Fourth People′s Hospital of Shenyang,Shenyang 110031,China)

机构地区：[1]沈阳市第四人民医院骨一科,沈阳110031

出　　处：《中华航海医学与高气压医学杂志》2020年第3期291-294,299,共5页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：目的探究高压氧辅助微创钢板内固定术治疗胫骨中下段骨折的疗效,并分析其对骨折处皮肤血运的影响。方法选取2016年1月至2018年12月入住沈阳市第四人民医院院骨一科的100例胫骨中下段骨折患者作为研究对象,按随机数字表法将其分为对照组(n=50)和观察组(n=50)。对照组患者给予微创钢板内固定术治疗,观察组在对照组治疗的基础上辅助高压氧治疗,连续治疗4周。比较术后1周、术后1个月及6个月2组患者疼痛视觉模拟评分(VAS)、骨折处皮肤血运情况、骨折愈合情况、骨密度及膝、踝关节功能。结果术后1周,观察组和对照组VAS、骨折愈合结痂评分、骨密度差异均无统计学意义(P>0.05)。术后1个月,观察组患者VAS、骨折愈合结痂评分及骨密度均优于对照组(P<0.05);观察组患者骨折处皮肤血运不良发生率为14.0%,明显低于对照组(32.0%)(P<0.05),而膝、踝关节功能优良率为58.0%,高于对照组(38.0%)(P<0.05)。术后6个月,和对照组相比,观察组患者VAS显著降低,骨密度明显增加,差异均有统计学意义(P<0.05);而骨折处皮肤血运不良发生率、骨折愈合结痂评分,以及膝、踝关节功能优良率优于对照组,但差异均无统计学意义(P>0.05)。结论高压氧联合辅助微创钢板内固定术治疗胫骨中下段骨折能够加速骨折处皮肤血运重建,减少组织水肿坏死,促进骨折愈合及减轻患者术后疼痛,可作为胫骨中下段骨折的辅助治疗手段。Objective To evaluate the curative effect of hyperbaric oxygen assisting minimally invasive plate osteosynthesis in treating the middle and distal tibia fracture and its influence on the blood supply.Methods One hundred cases of patients with tibial fractures from January 2016 to December 2018 admitted to the First Department of Ortho Pedics Forth People′s Hospital of Shenyang were selected and randomly divided into control group(n=50)and observation group(n=50).The control group was treated with minimally invasive steel plate osteoplasty,and the observation group was treated with hyperbaric oxygen therapy on the basis of the treatment of the control group for 4 consecutive weeks.The pain intensity scores measured by Visual Analog Scale(VAS),skin blood supply at the fracture site,fracture healing and scabbing,bone density,knee/ankle function were compared between the two groups 1 week,1 month,and 6 months after surgery.Results One week after surgery,the differences of VAS,fracture healing scores,and bone density between the groups all showed no statistical significance(P>0.05).One month after surgery,the VAS score,the score of fracture healing and scabbing,and the bone density of the observation group were significantly better than those of the control group(P<0.05).In the observation group,the incidence of poor blood supply to the skin at the fracture site was 14.0%,which was significantly lower than that of the control group(32.0%)(P<0.05).The recovery rate of the function of knee and ankle joints was 58.0%,which was higher than that in the control group(38.0%)(P<0.05).Six months after surgery,the VAS score of the observation group was significantly decreased,and the bone density in the observation group was significantly increased,compared with those of the control group.All differences were statistically significant(P<0.05).The blood supply to the skin,the fracture healing and scabbing,and the functional recovery of knee and ankle joints of the observation groups were better than those of the control group,

关 键 词：高压氧 微创钢板内固定术 胫骨中下段骨折 血运 

分 类 号：R687.3[医药卫生—骨科学]