闭合复位与切开复位交锁髓内钉治疗股骨干骨折疗效比较

Close versus open interlocking intramedullary nailing for femoral shaft fracture

目的比较闭合复位与切开复位交锁髓内钉治疗股骨干骨折的疗效。方法将76例股骨干骨折患者随机分为闭合复位组（37例）和切开复位组（39例）,术后对比术中出血量、骨折愈合时间、关节功能及并发症等。结果术中出血量：闭合复位组（220±60）ml,切开复位组（530±80）ml,两组比较差异有统计学意义（P〈0.05）。76例均获随访,时间715个月。骨折愈合时间：闭合复位组（4.8±2.1）个月,切开复位组（7.9±3.6）个月,两组比较差异有统计学意义（P〈0.05）。按照Kolmert膝关节功能评价标准：闭合复位组：优26例,良9例,可2例,优良率达94.6%,无感染、骨折延迟愈合、骨不连。切开复位组：优24例,良10例,可4例,差1例,优良率87.2%,骨折延迟愈合6例,4例经动力化后3个月骨折愈合,另2例再骨折。深部感染1例,两组比较差异有统计学意义（P〈0.05）。结论闭合复位交锁髓内钉治疗股骨干骨折优于切开复位。

Objective To compare the clinical effect of close reduction and open reduction for femoral shaft fracture with interlocking intramedullary nail.Methods 76 cases of femoral fracture were randomized into two groups,of which 37 patients were undergone close reduction,and 39 patients were undergone open reduction.After operation,the volume of blood loss,the period to union,the joints function and complication were compared.Results Blood loss was（220±60）ml in close reduction group and（530±80）ml in open reduction group（P〈0.05）.76 cases were all followed up for 715 months.The union period of close reduction group were（4.8±2.1）months,and（7.9±3.6）months,respectively（P〈0.05）.Based on the Kolmert score standardization of knee fuction,the results of 26 cases in close reduction group achieved excellent function,9 good and 2 fair.The excellent and good rate was 94.6%.No infection,delayed union or nonunion was found.For open reduction group,the results of 24 cases achieved excellent function,10 good,4 fair,and 1 poor.The excellent and good rate was 87.2%.6 cases got delayed union,including 4 cases become union by dynamic locking after 3 months and 2 cases got fracture again.1 case occurred deep-infection.And statistical significant were found between two groups（P〈0.05）.Conclusions Close reduction for femoral shaft fracture with interlocking nail is better than open reduction.