改良绞链石膏/支具在下肢长骨骨折康复治疗中的应用

Application of improved intermedullary nail and hinge brace in the rehabilitative treatment of long-bone fracture of lower limbs

目的:在下肢长骨骨折康复期治疗中应用改良绞链石膏/支具,观察其促进骨折愈合,减少关节僵硬等并发症的效果。方法:选择河北工程大学临床医学院骨科1984-01/2005-06收治的下肢长骨干骨折患者82例。分为实验组42例,采用符合生物固定要求的内固定后,应用外用改良铰链石膏/支具外固定。与传统绞链不同的是,近侧合叶片的联结点不是一个圆孔,而是一个按照膝关节瞬时中心曲线设计的滑道。使患者在3周后负重、持拐行走,利用骨折部合理的压应力促进骨折愈合。对照组40例,应用传统铰链石膏/支具配合符合生物力学要求的内固定。结果:82例患者平均获2年随访,均进入结果分析。①实验组患肢功能恢复情况:6～8周内愈合者22例(52.4%),9～12周全部愈合。②实验组不良事件和副作用:股骨及胫骨干骨折早期负重后Ender钉尾轻度外移3例,系断端嵌合不佳所致;骨折部半侧愈合不良1例;向外成角10°1例。无一例发生发生骨延迟愈合、不愈合及关节僵硬和明显的废用性肌萎缩。③两组患者术后膝关节活动度的比较:术后5,6,7周实验组患者膝关节活动度显著大于对照组(5周:(92.53±15.34)°比(80.12±16.41)°,6周:(108.48±16.35)°比(96.26±18.37)°,7周:(146.37±19.28)°比(135.21±17.65)°,t=2.73～3.54,P<0.01)④两组患者术后X射线检查骨痂出现率:术后4,5,6周实验组骨痂出现率显著高于对照组(0.52%比0.28%,0.67%比0.40%,0.88%比0.70%,χ2=4.08～5.86,P<0.05)。结论:下肢长骨干骨折采用内固定后,应用符合膝关节生物力学原理的改良绞链石膏/支具外固定,利用骨折部合理的压应力可促进骨折愈合。早期负重活动减少了因骨折长期卧床制动引起的股四头肌粘连、膝关节僵硬等多种并发症。

AIM： Through the application of improved intermedullary nail and hinge brace in the rehabilitative treatment of long,bone fracture of lower limbs, we are in an attempt to observe its effect in accelerating bone union and reducing the complications such as frozen knee joint. METHODS： We chosen 82 patients who suffered from long-bone fracture of lower limbs and received the treatment in the Department of Orthopaedics , Clinical Medical College , Hebei Engineering University between January 1984 and June 2005 . After internal fixation operation, improved intermedullary nail and hinge brace was used on 42 cases in the experimental group who suffered from long-bone fractures in lower limbs. Junction point of proximal lamina was not a round pore, but a slide designed according to instantaneous central curve of knee joint. Patients bore the load and walked with the help of crutch 3 weeks after operation. So the bone could get proper pressure, which was necessary to union. Traditional intermedullary nail and hinge brace combined with internal fixation which met the biomechanical demand was used on the 40 patients in the control group. RESULTS： Totally 82 patients were followed up for 2 years on average, and all of them entered the stage of result analysis.① Functional recovery. of affected limb of the experimental group ： 22 （52.4%）cases healed within 6 to 8 weeks , and completely healed within 9 to 12 weeks. ② Adverse events and side effect of the experimental group ： Ender nail tail shifted slightly toward the side after early load in 3 cases of femur and tibia fracture, which was caused by the poorengomphosis at the stump; Poor healing at the fracture part was found in 1 case; 1 case had 10 o outward angle. No one was found with delayed bone union, nonunion, frozen joint or obvious amyotrophy. ③ Comparison of postoperative activity of knee joint of the patients in the two groups ： the activity of knee joint of the patients at postoperative 5,6 and 7 weeks was significantly larger in the experimental group than in the control group [5 weeks：（92.53±15.34）°vs （80.12±16.41）°; 6 weeks： （108.48±16.35）°vs （96.26±18.37）°;7 weeks： （146.37±19.28）° vs （135.21±17.65）° ,t =2.73-3.54,P 〈 0.01].④ Frequency of bone callus detected by X-ray.： the frequency of bone callus at postoperative 4, 5 and 6 weeks was significantly higher in the experimental group than in the control group （0.52% vs 0.28% ,0.67% vs 0.40% ,0.88% vs 0.70% ,χ^2=4.08-5.86 ,P 〈 0.05 ）. CONCLUSION： After internal fixation is used for long-bone fracture in lower limb, improved intermedullary nail and hinge brace, which is accordance with biomachanieal theory, is used for external fixation. So, bone could get proper pressure for promoting bone union. Early loaded activity reduces the complications caused by long-term in bed, such as adhesion of museulus quadriceps femoris and frozen knee joint.