顺行髓内钉与钢板固定股骨远端关节外骨折比较  

Anterograde interlocking intramedullary nail versus locking plate for distal extraarticular femoral fractures

作　　者：陈洪强[1] 刘炯[1] 陈德斌[1] 吴德伟[1] 吴西智 叶赟 CHEN Hong-qiang;LIU Jiong;CHEN De-bin;WU De-wei;WU Xi-zhi;YE Yun(Department of Traumatic Orthopaedics,The Fourth People’s Hospital of Guiyang City,Guiyang 550003,China)

机构地区：[1]贵阳市第四人民医院创伤骨科,贵州贵阳550003

出　　处：《中国矫形外科杂志》2021年第4期303-306,共4页Orthopedic Journal of China

摘　　要：[目的]比较顺行交锁髓内钉结合阻挡钉技术与切开复位锁定钢板治疗股骨远端骨折的临床疗效。[方法]回顾性分析2016年1月~2019年1月本院收治的50例股骨远端骨折患者的临床资料。24例采用闭合复位顺行交锁髓内钉结合阻挡钉技术(髓内钉组),26例采用切开复位锁定钢板内固定术(钢板组)。比较两组围手术期、随访与影像资料。[结果]两组患者均顺利完成手术,术中无严重并发症。髓内钉组术中失血量及下地负重时间明显优于钢板组(P<0.05),但手术时间及透视次数显著差于钢板组(P<0.05),随术后时间推移,两组患者VAS评分显著减少(P<0.05),而HSS评分及膝关节活动度ROM显著增加(P<0.05)。术后各时间点两组VAS评分的差异无统计学意义(P>0.05),HSS评分术后各时间点髓内钉组明显优于钢板组(P<0.05),两组膝关节ROM术后3个月差异无统计学意义(P>0.05),但术后6、12个月髓内钉组明显优于钢板组(P<0.05)。影像方面:髓内钉组患者骨折均愈合,钢板组1例患者因骨不连、内固定断裂行翻修植骨内固定。在残余侧方移位及残余成角移位上,髓内钉组差于钢板组,而双侧股骨长度差异上髓内钉组优于钢板组(P<0.05)。[结论]两种技术治疗股骨远端骨折可以取得满意的疗效,相比之下,髓内钉技术的并发症更少,对术后活动度影响更小。[Objective] To compare the clinical outcomes of closed reduction and anterograde interlocking intramedullary nail versus open reduction and locking plate for distal extraarticular femoral fractures. [Methods] A retrospective study was conducted on 50 patients who underwent surgical treatment for distal extraarticular femoral fractures in our hospital from January 2016 to January 2019. Of them, 24 patients received closed reduction and anterograde interlocking intramedullary nail(IN) with blocking screw technique, while the remaining26 patients had conventional open reduction and internal fixation(ORIF) with locking plate. The perioperative, follow-up and radiographic documents were compared between the two groups. [Results] All the 50 patients in both groups had operation performed smoothly without serious complications. The IN group proved significantly inferior to the plate group regarding operation time and intraoperative X-ray exposure(P<0.05). All the 24 patients in the IN group got primary incision healing, while 2 of the 26 patients in the plate group suffered from superficial incision infection, which cured by dress changing. The VAS score significantly decreased, whereas the HSS score and knee extension-flexion range of motion(ROM) significantly increased over time postoperatively in both groups(P<0.05), while which were not statistically different at any matching time point postoperatively between the two groups(P>0.05). Regarding to radiographic assessment,there were no statistical differences in fracture reduction quality between the two groups in term of postoperative residual lateral displacement, angulation and shortening measured on images(P>0.05). [Conclusion] Both the surgical techniques do achieve satisfactory clinical outcomes for distal extraarticular femoral fractures. By comparison, the intermedullary nail has less chance of complication than the plate.

关 键 词：股骨远端关节外骨折 闭合复位 髓内钉 阻挡钉 解剖钢板 

分 类 号：R683.42[医药卫生—骨科学]