基层医院交锁髓内钉与动力加压接骨板治疗胫骨干骨折的变化趋势及疗效分析
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摘要
目的
对我院2004～2008年采用交锁髓内钉与动力加压接骨板治疗胫骨干骨折患者资料进行回顾性分析,以明确两种治疗手段在基层医院的应用趋势,并对2008年闭合性胫骨干骨折患者治疗疗效进行分析,从而为广大骨科基层骨科医师临床决策提供帮助。
材料和方法
研究纳入2004～2008年收入院胫骨干骨折初诊患者350例,按入院年份将患者分为5组,分析交锁髓内钉与动力加压接骨板治疗胫骨干骨折的应用趋势,同时对2008年度45例闭合性胫骨干骨折行交锁髓内钉或动力加压接骨板手术治疗患者的手术时间、出血量比较,并根据Johner-Wruhs疗效评价标准对患者预后进行评估。采用SPSS 15.0统计分析结果,计量资料用t检验,定性资料采用卡方检验。
结果
在基层医院,应用交锁髓内钉治疗胫骨干骨折,尤其是闭合性骨折的患者比例日趋增加,使用比例从2004年的18.33%增长到了2008年的41.02%,而闭合性骨折的应用比例更是达到了51.11%,交锁髓内钉与动力加压接骨板的术后并发症均逐渐降低,但交锁髓内钉较为显著。对2008年闭合性骨折患者资料的分析表明,交锁髓内钉治疗组手术时间与出血量均显著低于动力加压接骨板治疗组。交锁髓内钉治疗组与动力加压接骨板治疗组在感染、延期愈合、关节活动异常、短缩、成角畸形与旋转及神经血管损伤等方面的发病率无显著差异。
结论
在胫骨干骨折治疗方式方面,交锁髓内钉逐渐为基层医院采纳,交锁髓内钉与动力加压接骨板治疗胫骨干骨折的术后并发症逐年减少,交锁髓内钉减少较为显著,二者均是治疗胫骨干骨折的有效手段,患者预后较好,而交锁髓内钉比动力加压接骨板在手术时间、出血量方面有优势。临床选择时需要综合评价各种因素。
Objectives
Studies to explain the trend of changing pattern of the practice of Inter-locking intramedullary nail(IIN) and dynamic compression plate(DCP) are not enough in primary hospitals in China, though the two kinds of devices are most frequently used for patients with tibial shaft fractures.
Methods
350 patients with tibial shaft fractures were registered in the retrospective study in 2004-2008 to explain the trend of the changeing pattern of practice of IIN and DCP. Efficiency of IIN and DCP for patients with closed fracture in 2008 was evaluated, which observed outcomes were operative duration, blood loss during the operation, postoperative infection, pain, articulatory ranges of knees and ankles, fracture concrescence, nerves and blood vessels injuries, limbs length discrepancy and angular deformity. All statistics were analyzed by SPSS 15.0 software. Quantitative data were tested by t test while qualitative data byχ2 test.
Results
The augment of practice of IIN was observed with 18.33% in 2004 to 41.02% in 2008, while the device used in closed fracture was even more in patients with tibial shaft fracture, which was 51.11% in 2008. The complications of post-operation by IIN and DCP were reduced during the period. The comparision of efficiency with IIN and DCP to patients with closed tibial shaft fractures in 2008 showed that operative duration and blood loss in IIN group were significantly different from DCP group respectively. No significance was observed in infection, pain, articulatory ranges of knees and ankles, fracture concrescence, nerves and blood vessels injuries, limbs length discrepancy and angular deformity in the study.
Conclusions
IIN might have been in popularity in primary hospitals in China. Efficacy might be no difference in DCP and IIN for patients with tibial shaft fracture, while patient can get more benefit in less operative exposure and blood loss.
对我院2004～2008年采用交锁髓内钉与动力加压接骨板治疗胫骨干骨折患者资料进行回顾性分析,以明确两种治疗手段在基层医院的应用趋势,并对2008年闭合性胫骨干骨折患者治疗疗效进行分析,从而为广大骨科基层骨科医师临床决策提供帮助。
材料和方法
研究纳入2004～2008年收入院胫骨干骨折初诊患者350例,按入院年份将患者分为5组,分析交锁髓内钉与动力加压接骨板治疗胫骨干骨折的应用趋势,同时对2008年度45例闭合性胫骨干骨折行交锁髓内钉或动力加压接骨板手术治疗患者的手术时间、出血量比较,并根据Johner-Wruhs疗效评价标准对患者预后进行评估。采用SPSS 15.0统计分析结果,计量资料用t检验,定性资料采用卡方检验。
结果
在基层医院,应用交锁髓内钉治疗胫骨干骨折,尤其是闭合性骨折的患者比例日趋增加,使用比例从2004年的18.33%增长到了2008年的41.02%,而闭合性骨折的应用比例更是达到了51.11%,交锁髓内钉与动力加压接骨板的术后并发症均逐渐降低,但交锁髓内钉较为显著。对2008年闭合性骨折患者资料的分析表明,交锁髓内钉治疗组手术时间与出血量均显著低于动力加压接骨板治疗组。交锁髓内钉治疗组与动力加压接骨板治疗组在感染、延期愈合、关节活动异常、短缩、成角畸形与旋转及神经血管损伤等方面的发病率无显著差异。
结论
在胫骨干骨折治疗方式方面,交锁髓内钉逐渐为基层医院采纳,交锁髓内钉与动力加压接骨板治疗胫骨干骨折的术后并发症逐年减少,交锁髓内钉减少较为显著,二者均是治疗胫骨干骨折的有效手段,患者预后较好,而交锁髓内钉比动力加压接骨板在手术时间、出血量方面有优势。临床选择时需要综合评价各种因素。
Objectives
Studies to explain the trend of changing pattern of the practice of Inter-locking intramedullary nail(IIN) and dynamic compression plate(DCP) are not enough in primary hospitals in China, though the two kinds of devices are most frequently used for patients with tibial shaft fractures.
Methods
350 patients with tibial shaft fractures were registered in the retrospective study in 2004-2008 to explain the trend of the changeing pattern of practice of IIN and DCP. Efficiency of IIN and DCP for patients with closed fracture in 2008 was evaluated, which observed outcomes were operative duration, blood loss during the operation, postoperative infection, pain, articulatory ranges of knees and ankles, fracture concrescence, nerves and blood vessels injuries, limbs length discrepancy and angular deformity. All statistics were analyzed by SPSS 15.0 software. Quantitative data were tested by t test while qualitative data byχ2 test.
Results
The augment of practice of IIN was observed with 18.33% in 2004 to 41.02% in 2008, while the device used in closed fracture was even more in patients with tibial shaft fracture, which was 51.11% in 2008. The complications of post-operation by IIN and DCP were reduced during the period. The comparision of efficiency with IIN and DCP to patients with closed tibial shaft fractures in 2008 showed that operative duration and blood loss in IIN group were significantly different from DCP group respectively. No significance was observed in infection, pain, articulatory ranges of knees and ankles, fracture concrescence, nerves and blood vessels injuries, limbs length discrepancy and angular deformity in the study.
Conclusions
IIN might have been in popularity in primary hospitals in China. Efficacy might be no difference in DCP and IIN for patients with tibial shaft fracture, while patient can get more benefit in less operative exposure and blood loss.
引文
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[2]WHO.Injury:leading cause of the global burden of disease [J].WHO, Genevese,2000,8-20.[2]王声涌.伤害流行病学[M].北京：人民卫生出版社,2003,274-279
[3]曾凯生.骨牵引及管型石膏固定治疗胫腓骨干不稳定性骨折[J].中国骨伤,1999,12(1)49zggs199901032
[4]托马斯·鲁迪,克利斯托夫·邵墨.从AO传统加压接骨板到新型内固定器原则[J].中华创伤骨科杂志,2003,5(3)
[5]Frigg R. Locking compression plate(LCP). An osteosynthesis plate based on the dynamic compression plate and the point contact fixation(PC-FIX). Injury.2001:32(suppl2):6366
[6]PAPAKOSTIDIS C, GROTZ MR, PAPADOKOSTAKIS Qet al.Femoral biologic plate fixation[J]. Clin Orthop RelatRes,2006,450:193-202..
[7]Steinberg EL,Geller DS,Yacoubian SV,et al.Intramedullary fixation of tibial shaft fractures using an expandable nail:early results of 54 acute tibial shaft fractures.J Orthop Trauma 2006;20(5):303-309
[8]Smith WR,Ziran B,Agudelo JF,et al.Expandable intramedullary nailingfor tibial and femoral fractures:a preliminary analysis of perioperative complications.J Orthop Trauma 2006;20(5):310-314
[9]方国华,曾青东,孙新,等.带锁髓内钉与加压钢板治疗开放性胫腓骨折的比较.中国矫形外科杂志,2003,11(2)：143-144
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