第三骨折块周径和移位程度与髓内钉治疗股骨干骨折愈合的关系  

Correlation of circumference and displacement of the third fracture fragment with the healing of femoral shaft fractures treated with intramedullary nailing

作　　者：杨烁 封涛 陈舒畅 于健 张艳艳 霍永峰 顾光学 殷照阳 Yang Shuo;Feng Tao;Chen Shuchang;Yu Jian;Zhang Yanyan;Huo Yongfeng;Gu Guangxue;Yin Zhaoyang(Affiliated Lianyungang Hospital of Xuzhou Medical University(First People’s Hospital of Lianyungang),Lianyungang 222000,Jiangsu Province,China)

机构地区：[1]徐州医科大学附属连云港医院(连云港市第一人民医院),江苏省连云港市222000

出　　处：《中国组织工程研究》2024年第36期5839-5845,共7页Chinese Journal of Tissue Engineering Research

基　　金：江苏省卫健委“六个一工程”科研项目(LGY2020052),项目负责人:殷照阳。

摘　　要：背景:髓内钉治疗股骨干骨折后第三骨折块切开复位的指征存在较大的争议,部分学者认为有限切开复位能实现解剖复位,有利于骨折愈合;但亦有部分学者认为不切开复位第三骨折块仍有较高的骨折愈合率。目的:探讨髓内钉治疗合并第三骨折块的股骨干骨折术后,第三骨折块周径大小及移位程度在骨折愈合中的作用。方法:采用回顾性队列研究的方法,对2016年2月至2021年12月期间徐州医科大学附属连云港医院收治的142例股骨干骨折伴有第三骨折块患者的病历资料进行了分析,参考骨折处骨干周径,按第三骨折块的周径从小到大将骨折块分为3型:1型71例,2型52例,3型19例。参考骨折处骨干直径,按第三骨折块的移位程度从小到大分为3度:Ⅰ度95例,Ⅱ度31例,Ⅲ度16例。所有患者均行股骨骨折闭合复位髓内针内固定治疗,术中均未对移位的第三骨折块进行干预。术后进行随访,比较各组患者骨折愈合率、愈合时间及术后第9个月的改良胫骨放射愈合评分(mRUST),评估第三骨折块周径和移位程度对骨折愈合的影响。结果与结论:①共有142例患者获得12个月以上随访,平均随访时间为(14.7±4.1)个月,总体愈合率为73.4%;②第三骨折块Ⅰ度移位时,周径分型的3个亚组间的愈合率、愈合时间以及第9个月改良胫骨放射愈合评分差异无显著性意义;③第三骨折块Ⅱ,Ⅲ度移位时,周径分型3个亚组间的愈合率分和愈合时间差异无显著性意义;1型组的第9个月改良胫骨放射愈合评分高于2,3型组(P=0.017);④Logistic回归分析表明,第三骨折块移位较大、周径较大与较低的骨折愈合率相关(P<0.05);⑤结果表明,髓内钉治疗伴有第三骨折块的股骨干骨折,骨折块移位至Ⅰ度移位时,周径大小对于骨折愈合的影响较小,术中无需干预;骨折块移位至Ⅱ,Ⅲ度时,当周径大小为1型时,不干预骨折块亦可获得较高的改良BACKGROUND:After the treatment of femoral shaft fracture with the intramedullary nail,the third fracture open reduction indications are controversial.Some scholars believe that limited open reduction can achieve anatomical reduction,conducive to fracture healing;but some scholars believe that no open reduction of the third fracture still has a high fracture healing rate.OBJECTIVE:To investigate the effect of the circumference and displacement of the third fragment on fracture healing after intramedullary nailing of femoral shaft fractures with the third fragment.METHODS:A retrospective cohort study was conducted to analyze the clinical data of 142 patients suffered a femoral shaft fracture with a third fragment admitted to the Affiliated Lianyungang Hospital of Xuzhou Medical University from February 2016 to December 2021.The fracture were classified into three types according to the circumference of the third fracture with reference to the diaphyseal circumference at the fracture site:type 1 in 71 cases,type 2 in 52 cases,and type 3 in 19 cases.Referring to the diaphyseal diameter,the fractures were classified into three degrees according to the degree of the third fragment displacement:degree I in 95 cases,degree II in 31 cases,and degree III in 16 cases.All patients were treated with femoral interlocking intramedullary nails,and no intervention was performed for the displaced third fragment during the operation.Postoperative follow-up was performed to compare the fracture healing rate,healing time,and the modified Radiographic Union Scale for Tibia at month 9 after surgery in each group.The effect of third fracture fragment circumference and degree of displacement on fracture healing was assessed.RESULTS AND CONCLUSION:(1)All 142 patients were followed up for at least 12 months,with a mean of(14.7±4.1)months,and the overall healing rate was 73.4%.(2)When the third fragment was displaced by degree I,the healing rate,healing time,and modified Radiographic Union Scale for Tibia score at month 9 were not statisti

关 键 词：股骨干骨折 第三骨折块 微创复位 周径 移位程度 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R641