摘要
目的:比较股骨顺向髓内钉+钢丝环扎和桥接组合式内固定系统在治疗复杂多段股骨干骨折中的疗效和并发症。方法:复杂多段股骨干骨折行手术治疗的73例患者,随机分组,A组为股骨顺向髓内钉+钢丝环扎治疗组(36例)、B组为桥接组合式内固定系统治疗组(37例)。比较两组患者术中情况、术后疗效和并发症。结果:A组的切口长度、手术时间和术中出血量略小于B组,术中X线机透视次数A组显著多于B组,差异有统计学意义(P<0.05)。两组患者的术后患肢疼痛VAS评分、术后开始负重时间、髋关节Harris评分优良率、膝关节Hss评分优良率均相近,差异均无统计学意义(P>0.05)。而B组骨折愈合时间为(29±4.3)周,显著早于A组(32±5.6)周(P<0.05);A组的术后并发症发生率为19.4%,显著高于B组5.4%(P<0.05)。至随访结束,A组一期愈合率为86.1%,B组一期愈合率为100%。B组2例术后并发症均为切口感染。结论:两种手术方式均有效,当股骨干的骨折多节段、粉碎程度重且移位大时,更推荐桥接组合式内固定系统治疗,但桥接组合式内固定术后切口感染并发症不能忽视。
Objective:Comparison of the efficacy and complications of the treatment of complex multi-segment femoral shaft fractures with the use of femoral antegrade intramedullary nail and wire cerclage and bridge combined internal fixation system.Methods:The 73 patients with multi-segment femoral shaft fractures in group A were randomized into group A and B.36 patients in group A were treated with a combination of femoral antegrade intramedullary nail and wire cerclage,and 37 patients in group B were treated with a bridged internal fixation system.The general data,intraoperative conditions,postoperative efficacy and complications of the two groups of patients were recorded and compared.Results:The length of incision,operation time and intraoperative blood loss in group A were slightly smaller than those in group B,and the number of fluoroscopy in group A was significantly higher than that in group B,this difference were statistically significant(P<0.05).Conversely,the VAS score of the limb pain,the weight-bearing time,the excellent rate of hip Harris score and the excellent rate of knee joint Hss score after operation in group A were all similar to those of group B, and the difference was not statistically significant(P>0.05).However,the fracture healing time of group B was(29±4.3)weeks, which was significantly earlier than group A with(32±5.6)weeks(P<0.05).The postoperative complication rate of group A was 19.4%,which was significantly higher than 5.4% of group B(P<0.05).By the end of follow-up,the first-stage healing rate was 86.1% in group A and 100% in group B.In addition,the intraoperative complications of 2 patients in group B were incisional infection.Conclusion:These two surgical methods are effective for complex multi-segment femoral shaft fractures, and it is more recommended to use a combined bridge internal fixation system to treat the patient with multiple segments of the fracture, the large degree of comminution and large displacement,which can reduce the occurrence of complications. However,the complications of incision infection after bridged internal fixation can not be ignored.
作者
李璐华
衣龙云
李军
LI Luhua;YI Longyun;LI Jun(Department of Orthopedics,the First People’s Hospital of Liangshan Yi Autonomous Prefecture,Xichang City,Sichuan Province 615000)
出处
《医学理论与实践》
2020年第8期1217-1219,共3页
The Journal of Medical Theory and Practice
关键词
复杂多段股骨干骨折
股骨髓内钉
桥接组合式内固定系统
疗效
并发症
Complex multi-segment femoral shaft fracture
Femoral intramedullary nail
Bridge combined internal fixation system
Efficacy
Complications
