网站首页杂志简介编委会投稿须知期刊订阅过刊浏览广告合作在线留言联系我们
位置:首页 >> 电子期刊 >> 正文
双钢板内固定结合自体髂骨植骨治疗股骨干骨折术后无菌性骨不连疗效分析
作者: 孙贺孙亮薛汉中李忠张堃2
Authors: Sun He1, Sun Liang2,  Xue Hanzhong2, Li Zhong2, Zhang Kun2
单位: 1陕西中医药大学,咸阳712046;2西安交通大学附属红会医院创伤骨科 710054 通信作者:张堃,Email: hhyyzk@163.com
Units: 1Shaanxi University of Chinese Medicine, Xianyang 712046, China; 2Department of Orthopedies, Honghui Hospital, Xi′an Jiaotong University, Xi′an 710054, China Corresponding author: ZhangKun, Email: hhyyzk@163.com
关键词: 股骨;骨折;骨不连;髓内钉;骨移植
Keywords: Femur;Fracture; Nonunion; Intramedullary nail; Bone graft
分类号:
出版年,卷(期):页码:2020,47(3):175-181
摘要:

 目的  探讨双钢板内固定结合自体髂骨植骨治疗股骨干骨折术后无菌性骨不连疗效。方法  回顾性分析2017年1月—2018年12月西安交通大学附属红会医院收治的73 例股骨干骨折术后无菌性骨不连患者的临床资料,其中男性42 例,女性31 例,平均年龄40.63岁,年龄范围30~58 岁。按手术方式不同分为对照组(n=33)和观察组(n=40),对照组采用更换髓内钉治疗,观察组采用双钢板内固定结合自体髂骨植骨术治疗。比较两组患者围手术期一般指标(术中出血量、手术时长、术后引流量)、骨不连愈合情况、手术疗效;通过门诊随访,随访时间(15.24±4.72)  个月,随访截止时间2019年12月。术后6  个月时评估关节功能、关节活动度、视觉模拟评分法(VAS)和Oswestry功能障碍指数(ODI)的情况。计量资料以均数±标准差(Mean±SD)表示,组间比较采用独立样本t检验;计数资料以百分比(%)表示,独立样本采用χ2检验。等级资料采用Mann- Whitney U非参数检验。结果  两组患者均获得随访。观察组术中出血量、手术时长及术后引流量[(201.6±38.4) mL、(138.7±22.7) min、(25.8±6.9) mL]显著少于对照组术中出血量、手术时长及术后引流量[(278.5±40.6) mL、(171.4±20.1) min、(43.2±8.5) mL],两组比较差异具有统计学意义(P<0.05);术后骨不连愈合情况比较,观察组愈合时间(5.15±0.42) 个月明显短于对照组愈合时间(6.31±0.58) 个月,观察组愈合率(100%)明显高于对照组愈合率(90.1%),两组比较差异具有统计学意义(P<0.05);术后随访6 个月,两组患者关节功能优良率比较,观察组膝关节优良率(97.50%)及髋关节优良率(97.50%)显著优于对照组膝关节优良率(78.79%)及髋关节优良率(81.81%),两组比较差异具有统计学意义(P<0.05)。两组患者关节活动度比较,观察组膝关节活动度[伸展角度(0.64±0.14)°、屈曲角度(138.72±6.37)°]及髋关节活动度[内收角度(35.13±9.44)°、外展角度(74.38±5.22)°]明显优于对照组膝关节活动度[伸展角度(0.48±0.21)°、屈曲角度(113.57±5.43)°]及髋关节活动度[内收角度(21.57±8.63)°、外展角度(69.57±6.37)°],两组比较差异具有统计学意义(P<0.05)。观察组患者术后2周及术后4周VAS、ODI的疗效评分[(3.24±0.43) 分、(23.45±4.77) 分]明显优于对照组评分[(4.64±0.71) 分、(27.25±4.38) 分],两组比较差异具有统计学意义(P<0.05)。结论  双钢板内固定结合自体髂骨植骨术在治疗股骨干术后无菌性骨不连中疗效较为理想及显著,同时具有手术创伤小、术后恢复快、关节功能明显好转等优点,值得临床推广应用。

 Objective  To investigate the effect of double steel plate internal fixation combined with autogenous iliac bone grafting on aseptic nonunion after femoral shaft fractures. Methods  Retrospective analysis of clinical data of 73 patients with aseptic nonunion after femoral shaft fracture treatment was performed in department of orthopedies, Honghui Hospital, Xi′an Jiaotong University from January 2017 to December 2018, there were 42 males and 31 females, aged  30 to 58 years, with an average age of 40.63 years. They were divided into control group (n=33) and observation group (n=40) according to different surgical methods, the control group was treated with intramedullary nail replacement, and the observation group was treated with double steel plate internal fixation combined with autogenous iliac bone grafting. The general indicators of perioperative period (intraoperative blood loss, duration of operation, postoperative drainage), bone nonunion healing, and surgical efficacy were compared between the two groups. The follow-up time in outpatient clinic was (15.24 ± 4.72) months, and the follow-up deadline was December 2019. At 6 months after surgery, joint function, joint mobility, visual analogue scale (VAS) and Oswestry disability index(ODI) were evaluated. Measurement data were expressed as mean ± standard deviation (Mean ± SD), and  comparison between groups was analyzed using independent sample t test. Count data were expressed as percentage (%), and comparison between groups was analyzed using  χ2 test. Comparison of ordinal data was analyzed by Mann-whitney U non-parametric test.  Results  The patients in both groups were followed up. The amount of intraoperative blood loss, duration of operation, and postoperative drainage [(201.6±38.4) mL, (138.7±22.7) min, (25.8±6.9) mL] in the observation group were significantly less than those in the control group [(278.5±40.6) mL, (171.4±20.1) min, (43.2±8.5) mL], the differences were statistically significant between the two groups (P<0.05). Comparison of postoperative bone nonunion healing, the healing time of the observation group (5.15±0.42) months was significantly shorter than that of the control group (6.31±0.58) months, and the healing rate of the observation group (100%) was significantly higher than that of the control group (90.1%), the differences were statistically significant between the two groups (P<0.05). After 6 months of follow-up, the excellent and good rate of joint function  were compared between the two groups. The knee joint excellent and good rate (97.50%) and hip joint excellent and good rate (97.50%) in the observation group were significantly better than those of the control group (78.79%, 81.81%), the differences were statistically significant between the two groups (P<0.05). Comparison of joint mobility between the two groups of patients, knee joint mobility [extension angle (0.64±0.14) °, flexion angle (138.72±6.37) °]and hip joint activity [adduction angle (35.13±9.44) °, the abduction angle (74.38±5.22) °] were significantly better than the knee joint mobility [extension angle (0.48±0.21) °, flexion angle (113.57±5.43) °] and hip joint motion [adduction angle (21.57±8.63) °, abduction angle (69.57±6.37) °], the differences were statistically significant between the two groups (P<0.05). The VAS and ODI efficacy scores [(3.24±0.43), (23.45±4.77) scores]in the observation group were significantly better than those of the control group [(4.64±0.71), (27.25±4.38) scores] at 2 and 4 weeks after operation, the differences were statistically significant between the two groups (P<0.05). Conclusions  The double steel plate internal fixation combined with autologous iliac bone grafting is ideal and significant in the treatment of aseptic nonunion after femoral shaft fracture. Meanwhile, it has the advantages of less trauma throughout the operation, quicker postoperative recovery, and significantly improved joint function. It is worthy of clinical application.

基金项目:
作者简介:
参考文献:
服务与反馈:
文章下载】 【加入收藏
    广告合作

地址:北京市西城区永安路95号《国际外科学杂志》编辑部

 

邮编:100050               电话:010-63138570 

 

传真:010-63139265   Email: gjwkx@263.net 

 

投稿网址:http://www.cma.org.cn/html/main/index.html