阻挡钉技术在下肢长骨干骨折髓内钉固定术后肥大性骨不连中的疗效分析  

Analysis of therapeutic effect of blocking screw technique in hypertrophy nonunion after intramedullary nail fixation of long shaft fractures of lower limbs

作　　者：陈春冉 王万骥 郭召鹏 高凯 李春广 黄润堂 朱书朝 CHEN Chun-ran;WANG Wan-ji;GUO Zhao-peng;GAO Kai;LI Chun-guang;HUANG Run-tang;ZHU Shu-chao(Department of Trauma and Orthopedics,Nanyang Traditional Chinese Medicine Hospital,Nanyang,Henan 473000,China)

机构地区：[1]南阳市中医院创伤骨科,河南南阳473000

出　　处：《医药论坛杂志》2023年第24期72-76,共5页Journal of Medical Forum

摘　　要：目的探讨阻挡钉技术在下肢长骨干骨折髓内钉固定术后肥大性骨不连中的临床疗效。方法选取2019年1月至2021年12月南阳市中医院创伤骨科收治的下肢长骨干骨折髓内钉固定术后肥大性骨不连患者52例,术前将患者随机分为对照组及观察组(n=26)。所有患者均经髓内钉固定术治疗,对照组患者采取附加小钢板治疗,观察组患者采取阻挡钉治疗。结果两组患者在性别、年龄、骨折部位、AO分型及受伤原因方面无显著差异(P>0.05)。观察组患者切口长度(12.09±1.24)cm及术中出血量(190.89±23.47)mL显著低于对照组患者切口长度:(14.28±2.23)cm,术中出血量:(248.25±26.83)mL(P<0.001),手术时间(120.29±31.68)min及术中透视次数(29.53±11.36)次显著高于对照组患者手术时间(80.34±20.64)min,术中透视次数(13.41±4.84)(P<0.001)。两组患者术后切口均痊愈,未见切口感染及下肢深静脉血栓等并发症。观察组患者下地时间及完全负重活动时间均显著优于对照组患者(P<0.001)。术后12个月,观察组患者HSS评分及膝伸屈ROM均显著优于对照组(P<0.001)。观察组残余侧方移位及残余成角移位指标显著差于对照组(P<0.001);观察组患者双侧股骨长度差值显著优于对照组患者(P<0.001)。两组患者均达骨性愈合。结论下肢长骨干骨折髓内钉固定术后肥大性骨不连患者采用阻挡钉技术可更快地恢复患者的关节功能,使患者能够更早的下地活动,提高患者的生活质量。Objective To explore the effect of blocking screw technique in hypertrophy nonunion after intramedullary nail fixation of long shaft fracture of lower limbs.Methods Fifty-two patients with hypertrophy nonunion after intr⁃amedullary nail fixation of long shaft fractures of lower limbs admitted to Traumatic orthopedics Department of Nanyang City Hospital of Traditional Chinese Medicine from January 2019 to December 2021 were selected and randomly divided into control group and observation group before surgery(n=26).All patients had received intramedullary nail fixation,and the control group was treated with additional small plates,and the observation group was treated with blocking screw technique.Results There were no significant differences in gender,age,fracture site,AO type,and injury cause be⁃tween the two groups(P>0.05).Incision length(12.09±1.24)cm and intraoperative blood loss(190.89±23.47)mL in observation group were prominently lower than those in control group incision length(14.28±2.23)cm;Intraop⁃erative blood loss(248.25±26.83)mL(P<0.001),operative time(120.29±31.68)min and intraoperative fluoros⁃copy time(29.53±11.36)were significantly higher than those in control group operative time(80.34±20.64)min,intraoperative fluoroscopy time(13.41±4.84)(P<0.001).The incision of both groups recovered after operation,and no complications such as incision infection and lower extremity venous thrombosis were found.The time of first descent and full weight-bearing activity in observation group were markedly better than those in the control group(P<0.001).12 months after surgery,HSS score and knee extension ROM in observation group were prominently better than those in control group(P<0.001).The indexes of residual lateral displacement and residual angular displacement in observa⁃tion group were markedly worse than those in control group(P<0.001).The difference of bilateral femur length in the observation group was dramatically better than that in the control group(P<0.001).Bone healing was achieved

关 键 词：下肢长骨干骨折 髓内钉固定术 肥大性骨不连 阻挡钉技术 附加小钢板 

分 类 号：R683.42[医药卫生—骨科学]