股骨中上段骨折金属植入物内固定治疗及并发症分析:3组随机比较

Effect and complications of metallic implants for internal fixation of upper femoral shaft fracture:Randomized comparison among three groups

背景：临床多采用金属植入物内固定治疗股骨中上段干骨折,但由于骨折类型、手术操作及内固定方式或术后功能锻炼不当等容易发生并发症,目前关于不同金属植入物置入内固定治疗股骨干中上段骨折后并发症及其原因的系统研究报道尚少。目的：回顾性分析带锁髓内钉、加压钢板、梅花钉置入内固定治疗股骨干中上段骨折的临床效果及并发症情况。方法：选择中山大学附属博济医院骨科收治的股骨干中上段骨折患者92例,男63例,女29例,年龄18~65岁。随机分为带锁髓内钉内固定组、加压钢板内固定组、梅花钉内固定组,均采用常规手术入路及内固定方式。观察3组患者术后近期并发症、远期并发症、临床疗效及随访情况。结果与结论：①92例患者股骨干中上段骨折患者经切开复位内固定均获得成功。3组平均手术成功率及手术时间等差异均无显著性意义（P〉0.05）。②带锁髓内钉内固定组、加压钢板内固定组骨折愈合时间少于梅花钉内固定组,治愈率高于梅花钉内固定组（P〈0.05）。③股骨干中上段骨折内固定物弯曲断裂、骨折不愈合、再骨折及感染是主要并发症,带锁髓内钉内固定组并发症低于加压钢板内固定组及梅花钉内固定组（P〈0.05）。说明带锁髓内钉内固定更利于骨折愈合,但骨折部位和类型千变万化,内固定材料强度的差异和骨折复位情况不同,必须采取个体措施,避免或减少并发症的发生。

BACKGROUND：The upper femoral shaft fracture is clinically treated with internal fixation with metal implant.However,complications occur due to fracture type,operative and internal fixation method or functional exercise postoperatively.There are few reports on the upper femoral shaft following fracture internal fixation system complications and their causes.OBJECTIVE：To observe the clinical results and complications in the upper femoral shaft fracture following different internal fixation methods.METHODS：A total of 92 cases of femoral shaft fractures were selected from Department of Orthopedics,Boji Hospital of Zhongshan University,including 63 males and 29 females,aged 18 to 65 years.They were randomly divided into 3 groups,and respectively treated with interlocking intramedullary nail fixation with Internal fixation group,Compression plate Internal fixation group,Plum nail Internal fixation group,Three groups using the same surgical approach and the conventional internal fixation,3 groups were observed after surgery in patients with conditions,early complications,long-term complications,clinical,follow-up.RESULTS AND CONCLUSION：The 92 patients with the upper femoral shaft fractures were successfully treated with open reduction and internal fixation.The average success rate and the operation time displayed no significant difference among the groups（P 0.05）.The fracture healing time was less,but the cure rate was greater in interlocking nail group and plate fixation group than plum nail group（P 0.05）.The upper femoral shaft fracture,implant bending fracture,fracture nonunion,re-fracture and infection were major complications.Incidence of complications in interlocking intramedullary nail fixation group was lower than the compression plate fixation and plum nail groups（P 0.05）.Results show that interlocking intramedullary nail fixation facilitated fracture healing,but different fracture site and types,and various fixator material intensity and reduction conditions,the individualized treatment should be performed to prevent or reduce complications.