带锁髓内钉固定与钢板螺钉内固定治疗四肢创伤骨折后骨不连患者的临床效果比较  

Comparision of Clinical Effects of Intramedullary Nail with Lock and Plate Screw Fixation in Patients with Bone Nonunion After Limb Trauma Fracture of Extremities

作　　者：茹庆超 杨挺 张志昌 路坦[1] RU Qingchao;YANG Ting;ZHANG Zhichang;LU Tan(Department of Orthopedics of the First Affiliated Hospital of Xinxiang Medical University,Key Laboratory of Bone and Joint Dedegenerative Diseases of Xinxiang,Xinxiang 453100,China)

机构地区：[1]新乡医学院第一附属医院骨外科,新乡市骨关节退行性疾病研究重点实验室,河南新乡453100

出　　处：《河南医学研究》2024年第20期3688-3691,共4页Henan Medical Research

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190450)。

摘　　要：目的 对比带锁髓内钉(INWL)固定与钢板螺钉内固定治疗四肢创伤骨折后骨不连(NALTF)患者的效果。方法 回顾性收集新乡医学院第一附属医院76例NALTF患者(2022年5月至2023年10月)病例资料,按手术方案分两组。将接受INWL固定治疗的38例患者作为观察组,将接受钢板螺钉内固定治疗的38例患者作为对照组。对比两组手术效果、手术指标、视觉模拟评分法(VAS)、Constant-Murley肩关节功能评估量表(CMS)、美国特种外科医院膝关节评分(HSS)、血清相关细胞因子[β-胶原降解产物(β-CTX)、护骨素(OPG)、骨形态发生蛋白-2(BMP-2)]水平、并发症发生率。结果 与对照组手术优良率78.95%(30/38)对比,观察组97.37%(37/38)更高(P<0.05);与对照组对比,观察组术中出血量更低,骨折愈合、手术及住院用时更短(P<0.05);与术前对比,术后3个月,两组VAS评分降低,CMS、HSS评分升高,观察组VAS评分较对照组低,CMS、HSS评分较对照组高(P<0.05);与术前对比,术后3个月,两组血清β-CTX水平降低,OPG、BMP-2水平升高,观察组血清β-CTX水平较对照组低,OPG、BMP-2水平较对照组高(P<0.05);与对照组并发症发生率23.68%(9/38)对比,观察组2.63%(1/38)更低(P<0.05)。结论 与钢板螺钉内固定治疗NALTF患者对比,经INWL固定治疗可进一步提高手术效果,优化手术指标,减轻疼痛感,提升肩、膝关节功能,减少并发症,改善血清相关细胞因子水平,促进骨折愈合。Objective To compare the efficacy of intramedullary nail with lock(INWL)and plate screw fixation in the treatment of nonunion after limb trauma fracture(NALTF).Methods The data of 76 patients with NALTF(from May 2022 to October 2023)in the First Affiliated Hospital of Xinxiang Medical University were retrospectively collected and divided into two groups according to surgical protocols.Thirty-eight patients received INWL fixation were included as observation group,and 38 patients received plate screw fixation were included as control group.The surgical outcome,surgical indicators,visual analogue scale(VAS),Constant-Murley shoulder function assessment scale(CMS),American hospital for special surgery knee joint score(HSS),serum associated cytokines[β-collagen degradation products(β-CTX),osteoprotegerin(OPG),bone morphogenetic protein-2(BMP-2)]levels and complication rate were compared between the two groups.Results Compared with the control group,the excellent and good rate of operation was 78.95%(30/38),and the observation group[97.37%(37/38)]was higher(P<0.05).Compared with the control group,the observation group had lower intraoperative blood loss,shorter fracture healing,operation and hospitalization time(P<0.05).Compared with before surgery,3 months after surgery,VAS score of the two groups decreased,CMS and HSS scores increased,and VAS score of the observation group was lower than that of the control group,CMS and HSS scores were higher than those of the control group(P<0.05).Compared with pre-operation,serumβ-CTX level decreased and OPG and BMP-2 levels increased in both groups 3 months after operation.serumβ-CTX level in the observation group was lower than that in the control group,while serum OPG and BMP-2 levels were higher than those in control group(P<0.05).Compared with the control group,the complication rate was 23.68%(9/38),and the observation group[2.63%(1/38)]was lower(P<0.05).Conclusion Compared with plate screw internal fixation in NALTF patients,INWL fixation can further improve the surgical

关 键 词：四肢创伤骨折后骨不连 带锁髓内钉固定 血清相关细胞因子 关节功能 骨折愈合时间 

分 类 号：R683.4[医药卫生—骨科学]