旷置螺钉孔技术在钢板内固定治疗四肢骨干骨折的临床应用

The Clinical Application of Excluded Screw Hole Technology Used for Curing Limbs Shaft Fracture with Plate Internal Fixation

目的:探讨旷置螺钉孔对钢板螺丝钉内固定系统稳定性和骨折愈合的影响。方法:回顾性分析2010年3月-2012年3月收治的60例四肢骨干骨折患者的临床资料,根据是否主动旷置螺钉孔分为旷置组和非旷置组,每组各30例。分析比较两组患者总的疗效,包括:骨痂出现时间、骨折愈合时间(临床愈合、骨性愈合)、内固定失效率(骨不连发生率、钢板断裂发生率)、临床疗效等方面进行比较分析。结果:两组总疗效比较,旷置组优于非旷置组。临床疗效优良率:旷置组为93.3%,非旷置组为80%,两组比较差异有统计学意义(P<0.05)。术后出现骨痂时间:旷置组为(9.16±1.70)周,非旷置组为(11.20±1.60)周,两组比较差异有统计学意义(P<0.05);临床愈合时间:旷置组为(12.82±2.68)周,非旷置组为(15.36±3.66)周,两组比较差异有统计学意义(P<0.05);骨性愈合时间:旷置组为(4.51±1.46)个月,非旷置组为(7.06±1.21)个月,两组比较差异有统计学意义(P<0.05);术后旷置组骨不连发生率为0,非旷置组为3.3%;旷置组钢板断裂发生率为0,非旷置组为3.3%。结论:合理使用旷置螺钉孔技术对钢板螺丝钉内固定系统稳定性没有显著性影响,符合生物学固定原则;同时,由于有效保护骨折断端的血运,促进了骨折的愈合,减少骨不连、钢板断裂现象,是一种简单可行的操作技术,值得基层医院推广。

Objective： To investigate the effect of excluded screw hole on the internal fixed system＇s stability of steel plate screw and union of fracture.Method： The clinical data of 60 patients suffered from limbs shaft fracture,cured from March 2010 to March 2012 were analyzed retrospectively.And they were divided into excluded group and unexcluded group according whether the excluded screw hole was active or not,30 patients in each group. Then the totally curative effect of two groups were compared and analyzed,including osteotylus occurrence time,fracture healing time（clinical healing time,osseous healing time）,failure rate of internal fixation（incidence rate of nonunion, incidence rate of plate fracture） and clinical effect.Result：Compared the totally clinical effect of the two groups, excluded group was better than un-excluded group. The choice rate of clinical effect of excluded group and un-excluded group were 93.3% and 80% respectively,the difference was statistically significant（P〈0.05）.The osteotylus occurrence time after surgery of excluded group and un-excluded group were（9.16±1.70） weeks and（11.20±1.60） weeks respectively,the difference was statistically significant（P〈0.05）.Also, the clinical healing time and the osseous healing time between excluded group and un-excluded group had statistically significant differences（P〈0.05）,which were（12.82±2.68）weeks and（4.51±1.46）moths for excluded group,（15.36±3.66）weeks and（7.06±1.21）moths for un-excluded group. For the incidence rate of nonunion and incidence rate of plate fracture, excluded group were both 0 and un-excluded group were both 3.3%.Conclusion： Reasonable using of excluded screw hole has no effect on the internal fixed system＇s stability of steel plate screw, which conforms to the rule of biological fixation. At the same time, due to that the blood supply of fracture site is protected effectively, union of fracture is promoted, and the appearance of nonunion and plate fracture is reduced also. So it is a simple and practicable operative technique and worth being extended in primary hospitals.