發(fā)布時間：2018-06-13 05:33

  本文選題：股骨遠端骨折 + 逆行髓內(nèi)釘　； 參考：《安徽醫(yī)科大學》2015年碩士論文

【摘要】：目的:通過觀察比較分析股骨逆行髓內(nèi)釘與股骨遠端鎖定鋼板內(nèi)固定治療股骨遠端骨折的臨床療效,以探討內(nèi)固定治療股骨遠端骨折更佳的方法。材料與方法:1.研究對像:本研究為回顧性研究,分析了2007年2月至2014年3月期間收治的54例股骨遠端骨折患者,年齡在20~86歲之間(平均54.6歲),其中采用股骨逆行髓內(nèi)釘內(nèi)固定手術治療28例,采用股骨遠端鎖定鋼板內(nèi)固定手術治療26例。2.觀察指標:a.患者術前一般資料:性別、年齡、骨折類型、致傷原因、傷后至手術等待的時間。b.術中相關資料:手術時間、術中出血量。c.術后隨訪資料:骨折愈合的時間、膝關節(jié)的功能恢復情況的Kolmert評定。3.統(tǒng)計學處理:采用SPSS19.0統(tǒng)計軟件,計量資料用x±S表示,采用t檢驗,計數(shù)資料采用X2檢驗,評價兩組之間的療效比較,P0.05認為差異有統(tǒng)計學意義。結果:54例患者術后獲得8~24個月(平均12.8個月)隨訪,所有病例均獲得了骨性愈合。逆行髓內(nèi)釘組:28例行股骨逆行髓內(nèi)釘內(nèi)固定手術治療,受傷至手術的平均等待時間為5.68±2.67天,平均手術時間為154.64±56.07min,術中平均出血量為388.57±170.77ml。全部獲得隨訪,其中出現(xiàn)膝關節(jié)中輕度疼痛1例,無感染、內(nèi)固定松動等并發(fā)癥。隨訪后本組的平均骨折愈合時間為22.54±2.95周。根據(jù)Kolmert膝關節(jié)功能評定系統(tǒng)進行評定,在本組患者中,優(yōu):18例,良:6例,可:4例,差:0例,優(yōu)良率85.7%。2.鎖定鋼板組:26例行鎖定鋼板內(nèi)固定手術治療,受傷至手術的平均等待時間為5.42±2.21天,平均手術時間為131.73±72.99min,術中平均出血量為403.85±242.46 ml。全部獲得隨訪,其中出現(xiàn)輕度膝內(nèi)翻畸形2例,出現(xiàn)深靜脈血栓1例,無感染、內(nèi)固定松動等并發(fā)癥。隨訪后本組的平均骨折愈合時間為24.96±3.70周。根據(jù)Kolmert膝關節(jié)功能評定系統(tǒng)進行評定,在本組患者中,優(yōu):16例,良:5例,可:4例,差:1例,優(yōu)良率80.8%。3.數(shù)據(jù)統(tǒng)計結果:在逆行髓內(nèi)釘組和鎖定鋼板組,在手術時間和術中出血量、膝關節(jié)功能優(yōu)良率方面兩組比較,結果無統(tǒng)計學差異(P0.05)。在骨折愈合時間方面,髓內(nèi)釘組和鎖定鋼板組分別為22.54±2.95周和24.96±3.70周,兩組比較,髓內(nèi)釘組較鎖定鋼板組愈合時間短,結果有統(tǒng)計學差異(P0.05)。結論:逆行髓內(nèi)釘與鎖定鋼板均是內(nèi)固定治療股骨遠端骨折的有效方法。相比較而言,逆行髓內(nèi)釘較鎖定鋼板內(nèi)固定治療股骨遠端骨折所需的骨折愈合時間短,更有利于骨折愈合;在膝關節(jié)功能的恢復方面,兩者均能獲得滿意的療效。
[Abstract]:Objective: to compare and compare the clinical effect of retrograde intramedullary nail and locking plate fixation on distal femoral fracture and to explore the better method of internal fixation for distal femoral fracture. Materials and methods: 1. Subjects: this study was a retrospective analysis of 54 patients with distal femur fractures who were treated between February 2007 and March 2014, aged between 20 and 86 years (mean 54.6 years old), 28 of whom were treated with retrograde intramedullary nail fixation. 26 cases were treated by internal fixation with locking plate of distal femur. The observation index is: A. Preoperative general data: sex, age, fracture type, cause of injury, time from injury to operation. Intraoperative data: operation time, intraoperative bleeding volume. Postoperative follow-up data: fracture healing time, knee function recovery of Kolmert rating. 3. Statistical processing: SPSS 19.0 statistical software, measurement data expressed by x 鹵S, using t test, count data using X2 test, the evaluation of the two groups of curative effect comparison P0.05 think there is statistical significance. Results 54 cases were followed up for 824 months (mean 12.8 months). In retrograde intramedullary nail group, 28 cases were treated with retrograde femoral intramedullary nail fixation. The average waiting time from injury to operation was 5.68 鹵2.67 days, the average operative time was 154.64 鹵56.07 min, and the average intraoperative bleeding was 388.57 鹵170.77 ml. All cases were followed up, including 1 case of mild knee pain, no infection, loosening of internal fixation and other complications. The average healing time was 22.54 鹵2.95 weeks after follow-up. According to Kolmert knee joint function evaluation system, in this group, 18 cases were excellent: 18 cases, 6 cases good: 6 cases, 4 cases: may: 4 cases, 0 cases poor: 0 cases, the excellent and good rate was 85.75.0.2. The average waiting time from injury to operation was 5.42 鹵2.21 days, the average operation time was 131.73 鹵72.99 minutes, and the average blood loss during operation was 403.85 鹵242.46 ml. All cases were followed up, including 2 cases of mild varus genu deformity, 1 case of deep venous thrombosis, no infection, loosening of internal fixation and other complications. The average healing time was 24.96 鹵3.70 weeks. According to Kolmert knee joint function evaluation system, 16 cases were excellent in this group, 5 cases were good: 5 cases were good, 4 cases were fair, 1 case was poor. The excellent and good rate was 80.8.3. Results: in the retrograde intramedullary nail group and the locking plate group, there was no significant difference between the two groups in the operation time, intraoperative bleeding volume, and the excellent and good rate of knee joint function. There was no significant difference between the two groups (P 0.05). The healing time of intramedullary nail group and locking plate group were 22.54 鹵2.95 weeks and 24.96 鹵3.70 weeks, respectively. The healing time of intramedullary nail group was shorter than that of locking plate group (P 0.05). Conclusion: both retrograde intramedullary nail and locking plate are effective methods for the treatment of distal femur fracture. In comparison, retrograde intramedullary nail has shorter healing time than locking plate fixation for distal femur fracture, which is more beneficial to fracture healing. Both of them can obtain satisfactory results in the recovery of knee joint function.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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本文編號：2012908