四肢长管状骨骨干骨折不同术式疗效比较

Comparison of Effects of Fixation Devices in Treatment of Limbs Long Cannon Bone Shaft Fracture

目的 探讨不同手术固定方式在四肢长管状骨骨干骨折不同类型固定中的优缺点。方法 对 32 3例四肢长管状骨骨干骨折 ,分别采用带锁髓内钉 (LIN)、加压钢板 (DCP)和单侧外固定架 (UADF) 3种固定器材手术固定 ,对其骨折情况、手术资料及疗效进行临床随访分析及统计对比。结果 三者手术时间、出血量均为外固定架组最少 (P <0 0 5 ) ;切口长度外固定架组和带锁髓内钉组无差异 (P >0 0 5 )均较加压钢板组短 (P <0 0 5 ) ;骨性愈合率带锁髓内钉组最高 (P <0 0 5 ) ,延迟愈合率、不愈合率、畸形愈合率、固定松动率、固定 (钉 /板 )断裂率带锁髓内钉组最低 (P <0 0 5 )。结论 外固定架最适合于严重开放性骨折及伤口感染的骨折 ,但稳定性差 ;加压钢板虽然可应用于任何部位的四肢长管状骨骨干骨折 ,但骨折愈合率较低 ,术后固定物松动、断裂率均较高 ,主要用于髓腔宽大的不易交锁髓内钉应用的长管状骨骨干的上下 1/ 3端 ,同时慎用于开放性骨折 ;交锁髓内钉稳定性最好 ,骨折愈合率最高 ,最适合严重粉碎和骨干中段的横断和短斜型四肢长管状骨骨干骨折及陈旧性骨折不愈合或延迟愈合 ;由于其可靠的固定作用及对软组织损伤小 ,同时适合于开放性骨折Ⅰ型、Ⅱ型、ⅢA型。

Objective To explore the virtues and defects of different fixation styles in fracture.Methods 323 limbs long cannon bone shaft fracture cases were fixed differently by unilateral axial dynamie fixation (UADF),locked intramedullary nailing(LIN) and dynamic compression plate(DCP).Then the difference of their fracture condition operation data and curative effect were contrasted.Results Surgery time and intraoperation bleeding in DCP group were lowest(P<0.05).Length of incision in LIN group and UADF group were shorter than in DCP group(P<0.05). The bone healing rate in LIN group was the highest(P<0.05) and the rate of bone non-union,deformity and inefficient fixation were the lowest in three groups(P<0.05).Conclusion UADF is the best style for open fracture and infection fracture but its stability is worse.DCP fits for the fracture of various parts of limbs long cannon bone shaft especially the fracture near joint.It is not suited to open fracture.And there is higher rate of bone non-union,deformity of DCP. LIN is the best treatment of severe malunion fracture,median part fracture of limbs long cannon bone shaft and old fracture.Its stability is the best.It also fits for open fracture of Ⅰ、Ⅱ、Ⅲ A type.