经皮神经电刺激治疗胫骨骨折术后骨不连的临床应用效果  

Clinical Application of Transcutaneous Electrical Nerve Stimulation in Postoperative Nonunion of Tibial Fractures

作　　者：胡金凤[1] 吴飞[1] 孙虹[1] HU Jin-feng;WU Fei;SUN Hong(Department of Orthopedics, Renmin Hospital of Wuhan University,Wuhan 430060, Hubei, China)

机构地区：[1]武汉大学人民医院骨科,湖北武汉430060

出　　处：《中国现代手术学杂志》2022年第2期128-133,共5页Chinese Journal of Modern Operative Surgery

基　　金：国家自然科学基金青年科学基金项目(81301052)。

摘　　要：目的观察经皮神经电刺激(transcutaneous electrical nerve stimulation,TENS)治疗胫骨骨折髓内钉固定术后骨不连的临床应用效果。方法回顾性分析57例胫骨骨折髓内钉固定术后骨不连患者的临床资料,依据治疗方法分为试验组及对照组。试验组27例,采用TENS治疗;对照组30例,采用再次内固定手术治疗。分别比较两组患者的临床疗效、膝关节及踝关节功能、愈合时间、骨愈合指数及并发症发生率等指标。结果试验组优17例,良8例,差2例,对骨不连治疗后3个月美国膝关节协会评分(American Knee Society score,AKSS)平均为(178.85±7.55)分,Olerud-Molander踝关节功能评分平均为(88.81±3.95)分,骨不连愈合时间8~20周,平均(14.24±3.22)周,骨愈合指数(10.91~40.00)周/cm,平均(15.92±5.69)周/cm;对照组优15例,良12例,差3例,再手术后3个月AKSS(174.97±8.36)分,Olerud-Molander踝关节功能评分(87.33±3.17)分,骨不连愈合时间8~20周,平均(14.41±3.29)周,骨愈合指数9.23~26.67周/cm,平均(17.57±6.01)周/cm。以上各项指标两组间比较均无统计学差异(P>0.05)。结论对于无明显内固定不稳的胫骨骨折髓内钉固定术后骨不连患者,TENS治疗与再手术治疗临床疗效相似。而TENS治疗可避免二次手术带来的创伤及费用等问题,在严格把握适应证的前提下值得推广应用。Objective To observe the clinical effect of transcutaneous electrical nerve stimulation(TENS)in the treatment of nonunion after intramedullary nail fixation of tibial fractures.Methods In this retrospective study,patients with nonunion after intramedullary nail fixation of tibial fractures were divided into the study group treated with TENS(n=27)and the control group treated with re-operation(n=30).The clinical efficacy,knee and ankle functions,healing time,index of bone healing and complication rates were respectively compared between these two groups.Results In the study group,there were 17 cases of excellent,8 of good and 2 of fair.3 months after TENS,American Knee Society score(AKSS)was 178.85±7.55 and Olerud-Molander ankle function score was 88.81±3.95.Healing time of the nonunion was 8~20 weeks,with an average of(14.24±3.22)weeks,and the index of bone healing was 10.91~40.00 weeks/cm,with an average of(15.92±5.69)weeks/cm.In the control group,there were 15 cases of excellent,12 of good and 3 of fair.3 months after re-operation,AKSS was 174.97±8.36 and Olerud-Molander ankle function score was 87.33±3.17.Healing time of the nonunion was 8~20 weeks,with an average of(14.41±3.29)weeks,and the index of bone healing was 9.23~26.67 weeks/cm,with an average of(17.57±6.01)weeks/cm.There were no statistical differences between the two groups in all the index(P>0.05).Conclusion For patients with nonunion after intramedullary nail fixation of tibial fractures without obvious internal fixation instability,the clinical efficacy of TENS is similar to that of re-operation.However,TENS can avoid the trauma and cost caused by the second operation,which is worth popularizing on the premise of strictly grasping the indications.

关 键 词：经皮神经电刺激 骨不连 胫骨骨折 髓内钉 骨愈合指数 

分 类 号：R683.42[医药卫生—骨科学]