开放与闭合复位髓内钉内固定对股骨干骨折的疗效及安全性比较

Comparison of Efficacy and Safety between Open and Closed Reduction and Intramedullary Nailing for Femoral Shaft Fractures

目的开放与闭合髓内钉内固定术式对股骨干骨折的疗效及安全性比较。方法选择2015年3月到2016年3月在医院接受手术治疗的股骨干骨折患者130例作为研究对象。根据简单数字随机表法将患者分成观察组以及对照组各65例,对照组给予闭合髓内钉内固定术式,观察组给予小切口的开放髓内钉内固定术式,随访6个月,对比两组的疗效指标,术中放射剂量,治疗前后的血红蛋白(hemoglobin,Hb)和红细胞比容(hematocrit,HCT)以及并发症情况。结果观察组的手术时间、出血量、住院时间和骨折愈合时间与对照组相比,差异均无统计学意义(均P>0.05)。观察组在胸部、腹部、甲状腺及性腺的放射剂量均明显低于对照组,差异均有统计学意义(P<0.05)。两组术后7 d的Hb组内比较均明显低于术前,差异有统计学意义(P<0.05),组间比较的差异无统计学意义(P>0.05)。观察组的并发症总发生率是6.16%,与对照组的13.85%相比,差异无统计学意义(P>0.05)。结论对于股骨干骨折需接受髓内钉内固定术,可考虑切口较小的开放复位,不但能够获得等同于闭合复位的疗效,而且患者接受的放射剂量也明显更低,安全性较好,值得推广。

Objective To compare the efficacy and safety of open and closed reduction and intramedullary nailing in the treatment of femoral shaft fractures. Methods 130 cases of femoral shaft fractures treated in our hospital from March 2015 to March 2016 were selected as the study subjects. The patients were divided into the observation group and the control group according to the simple digital random table method,with 65 cases for each. The control group was treated with closed reduction and intramedullary nailing,and the observation group was treated with open reduction with small incision and intramedullary nailing. The patients were followed up for 6 months,therapeutic indices were compared between the two groups,including intraoperative radiation dose,blood biochemical indices（hemoglobin and hematocrit） before and after treatment and complications. Results Operation time and blood loss of the observation group,as well as the length of hospital stay and fracture healing time were not statistically significant combined with the control group（P 0. 05）. The radiation doses of the chest,abdomen,thyroid gland and gonad of the observation group were significantly lower than the control group（P 0. 05）. The 7-day postoperative Hb levels of the two groups were significantly lower than the preoperative one（P 0. 05）,but there was no significant difference between the two groups（P 0. 05）. And there was no difference of the Hct levels（P 0. 05）. The complication rate of the observation group was 6. 16%,which was not significantly lower than the control group（P 0. 05）,although that was13. 85%. Conclusion The open reduction with a small incision should be taken into consideration for femoral shaft fractures,not only for its equivalent effect of the closed reduction,but also for its low radiation dose.It is worthy of promotion.