不同动力化方式治疗髓内钉固定后胫骨干骨折愈合不良的效果分析  

Effects of different dynamic methods in the treatment of poor healing after tibial fracture fixed by intramedullary nailing

作　　者：余璐鑫 罗辑 杨博文 周新 周慧生 YU LU-xin;LUO Ji;YANG Bo-wen;ZHOU Xin;ZHOU Hui-sheng(Department of Orthopedics,Chongqing University Jiangjin Hospital,Chongqing,402260,China)

机构地区：[1]重庆大学附属江津医院(重庆市江津区中心医院)骨关节外科,402260

出　　处：《中国骨与关节杂志》2024年第9期680-685,共6页Chinese Journal of Bone and Joint

基　　金：重庆市自然科学基金(cste2021jcyj-msxmX0904)。

摘　　要：目的分析不同动力化方式处理胫骨干骨折髓内钉固定术后骨折愈合不良的效果,为临床治疗提供参考。方法回顾分析2003年8月至2023年8月,我院骨科采用动力化方式治疗的30例交锁髓内钉固定术后胫骨干骨折愈合不良患者的临床资料。根据动力化的方式将患者分为两组:远端动力化组22例,其中男8例,女14例,平均年龄43.86岁;近端动力化组8例,其中男6例,女2例,平均年龄45岁。收集两组患者动力化手术的时间、出血量、骨折最终愈合情况、骨折愈合后是否存在患肢短缩、内固定取出手术时间、术中出血量、内固定取出住院费用等。使用SPSS进行统计学分析,评估两组各项指标存在的差异是否有统计学意义。结果两组在动力化手术时间、出血量、患肢明显短缩率方面的比较差异无统计学意义。近端动力化组在术中透视次数相对较少[(1.13±0.35)次vs.(1.50±0.51)次],并且后期骨折愈合率方面要优于远端动力化组(87.50%vs.54.55%),差异均有统计学意义(P<0.05)。骨折愈合的患者中远端动力化组在内固定取出手术时间[(59.75±18.03)min vs.(93.43±25.16)min]、术中出血量[(15.31±11.03)ml vs.(60.00±23.09)ml]、术中透视次数[(1.44±0.63)次vs.(3.14±0.90)次]、住院费用[(7077.31±613.37)元vs.(7999.29±547.18)元]等方面均明显优于近端动力化组,差异均有统计学意义(P<0.05)。但在住院天数、术后疼痛评分方面两组差异无统计学意义。结论远、近端动力化均是治疗胫骨骨折愈合不良的有效方法。相对而言,近端动力化的成功率更高,但后期内固定取出较为困难。Objective To analyze the impact of different dynamic treatments on tibial shaft fracture following intramedullary nail fixation and provide clinical treatment references.Methods This retrospective analysis was conducted at the Department of Orthopedics,Jiangjin Hospital Affiliated to Chongqing University,from August 2003 to August 2023.Clinical data of 30 patients with poor healing of tibial shaft fractures after interlocking intramedullary nail fixation were included.The patients were divided into two groups based on the method of dynamization:distal dynamization group(n=22)included 8 males and 14 females with an average age of 43.86 years;proximal dynamic group(n=8)included 6 males and 2 females with an average age of 45 years.Parameters such as dynamic operation time,blood loss,final fracture healing status,limb shortening after fracture healing,operation time for internal fixation removal,intraoperative blood loss,and hospitalization cost for internal fixation removal were collected in both groups.Statistical analysis using SPSS was performed to evaluate whether there were statistically significant differences between the two groups.Results There was no significant difference between the two groups in terms of dynamic operation duration,blood loss volume,and rate of shortening in the affected limb.However,the proximal group had a relatively lower frequency of fluoroscopy during dynamic surgery[(1.13±0.35)vs.(1.50±0.51)]and showed a better rate of fracture healing in the later stage compared to the distal dynamic group(87.50%vs.54.55%)with statistical significance(P<0.05).Among patients with fracture healing,the distal dynamic group had shorter operative time for internal fixation extraction[(59.75±18.03)min vs.(93.43±25.16)min],less intraoperative blood loss[(15.31±11.03)ml vs.(60.00±23.09)ml],lower intraoperative fluoroscopy frequency[(1.44±0.63)vs.(3.14±0.90)],and lower hospitalization costs[(7077.31±613.37)vs.(7999.29±547.18)]compared to the proximal dynamic group;these differences were statistic

关 键 词：胫骨骨折 骨折固定术 髓内 骨钉 骨折 不愈合 动力化 

分 类 号：R683.4[医药卫生—骨科学]