斯氏针辅助与徒手复位顺行髓内钉固定远端股骨干骨折的疗效比较  

A comparative research of Steinman pin-assisted and manual reduction for distal femoral fractures with anterograde intramedullary nail

作　　者：许新忠[1] 徐春归[1] 高哲辰 张积森[1] 赵耀[1] 余水生[1] 叶曙明[1] 荆珏华[1] Xu Xinzhong;Xu Chungui;Gao Zhechen;Zhang Jisen;Zhao Yao;Yu Shuisheng;Ye Shuming;Jing Juehua(Department of Orthopaedics,the Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院骨科,合肥230601

出　　处：《中华骨科杂志》2020年第17期1190-1196,共7页Chinese Journal of Orthopaedics

摘　　要：目的比较斯氏针辅助与徒手复位顺行髓内钉固定远端股骨干骨折的疗效。方法回顾性分析2014年1月至2018年8月收治并获得完整随访的54例远端股骨干骨折患者资料。根据骨折复位方式分为徒手复位组和斯氏针辅助复位组(简称斯氏针复位组)。徒手复位组26例,男16例,女10例;年龄(37.5±9.2)岁(范围,21~59岁);骨折AO/OTA分型:32-A型16例,32-B型7例,32-C型3例;受伤至手术时间(7.9±6.2)d。斯氏针复位组28例,男19例,女9例;年龄(36.4±9.8)岁(范围,18~55岁);骨折AO/OTA分型:32-A型19例,32-B型7例,32-C型2例;受伤至手术时间(9.2±6.4)d。比较两组复位时间、透视次数、术中出血量、骨折愈合时间、美国特种外科医院(hospital for special surgery,HSS)膝关节功能评分。结果术中出血量,斯氏针复位组(94.81±17.71)ml,徒手复位组(142.78±29.76)ml;骨折复位时间,斯氏针复位组(5.02±1.69)min,徒手复位组(14.19±2.50)min;复位时透视次数,斯氏针复位组(5.01±1.51)次,徒手复位组(12.56±2.01)次;以上指标比较差异均有统计学意义(t=12.19,4.02,5.47;均P<0.05)。54例患者均获得随访,随访时间平均23.4个月(范围,12~51个月);骨折均愈合,无一例发生延迟愈合及不愈合,斯氏针复位组愈合时间(5.99±0.97)个月,徒手复位组(7.01±1.15)个月,两组比较差异无统计学意义(t=1.35,P=0.247)。膝关节功能HSS评分,徒手复位组术前(23.7±4.1)分,术后1、2、3、6、12个月分别为(61.3±4.5)分、(70.2±4.2)分、(78.9±5.9)分、(87.9±4.6)分、(93.1±5.8)分;斯氏针复位组术前(22.5±3.8)分,术后1、2、3、6、12个月分别为(62.2±5.1)分、(69.1±4.7)分、(79.2±4.3)分、(88.6±5.3)分、(92.3±6.1)分;各时间点两组间比较差异均无统计学意义(t=1.113,0.689,0.908,0.212,0.519,0.494,均P>0.05);两组术前及术后各时间点比较,差异有统计学意义(F=716.42,815.52,均P<0.001)。术后斯氏针复位组未发生进针点感染、血管神经损伤、内固�Objective To compare of the efficacy of Steinman pin-assisted and manual reduction for the treatment of distal femoral fracture with anterograde intramedullary nail.Methods From January 2014 to August 2018,data of 54 patients with distal femoral fracture were retrospectively analyzed.According to the fracture reduction methods,patients were divided into two groups:bare-handed reduction group and Steinman pin-assisted reduction group(referred to Steinman pin group).There were 16 males and 10 females in bare-handed reduction group,with age of 37.5±9.2 years(range,21-59 years).According to AO/OTA classification,16 cases were type 32-A,7 type 32-B,3 type 32-C.There were 19 males and 9 females in Steinman pin reduction group,with age of 36.4±9.8 years(range,18-55 years).According to AO/OTA classification,19 cases were type 32-A,7 type 32-B,2 type 32-C.The reduction time,fluoroscopy times,intraoperative blood loss,fracture healing time,and knee joint function score of American hospital for special surgery(HSS)were compared between the two groups.Results The amount of blood loss during operation was 142.78±29.76 ml in the bare-handed group,and 94.81±17.71 ml in the Steinman pin group.The reduction time of fracture was 14.19±2.50 min in the bare-handed group and 5.02±1.69 min in the Steinman pin group.The times of fluoroscopy during reduction was 12.56±2.01 in the bare-handed group and 5.01±1.51 in the Steinman pin group.There were significant differences in the above indexes(t=12.19,4.02,5.47;all P<0.05).All 54 patients were followed up for 12-51 months,with an average of 23.4 months.All the fractures healed,and there was no delayed union or nonunion.The healing time was 7.01±1.15 months in the bare-handed group and 5.99±0.97 months in the Steinman pin group.There were no significant difference.The HSS score of knee joint function was 23.7±4.1 before operation,61.3±4.5 at 1 month after operation,70.2±4.2 at 2 months after operation,78.9±5.9 at 3 months after operation,87.9±4.6 at 6 months after operation,

关 键 词：股骨骨折 骨折固定术 髓内 骨折愈合 

分 类 号：R687.3[医药卫生—骨科学]