2种复位方法治疗股骨干粉碎性骨折的疗效观察

The comparison of curative effects of two different reduction methods in the treatment of comminuted femoral shaft fracture

目的观察闭合复位和有限切开复位带锁髓内钉术治疗股骨干粉碎性骨折临床疗效及探讨不同复位方法的选择。方法回顾分析2012年3月—2015年5月在本院接受闭合复位髓内钉内固定术(Ⅰ组)和有限切开复位带锁髓内钉内固定术(Ⅱ组)治疗的股骨干骨折患者36例的相关资料。比较两组患者的手术时间、术中出血量、术后并发症、骨折愈合时间及膝关节功能改善情况。结果Ⅰ组手术时间(100.26±6.99)min显著长于Ⅱ组(94.06±4.01)min,(t=3.2114,P<0.05);Ⅰ组术中出血量显著少于Ⅱ组,(t=14.5887,P<0.05)所有患者均获得随访,随访时间为12~18个月。两组患者愈合时间分别为(9.11±1.12)月和(6.59±0.96)月,两组比较差异有统计学意义(t=7.2286,P<0.05)。按Kotmert评分,术后12月随访显示:Ⅰ组膝关节功能改善优良率84.21%,显著高于Ⅱ组64.70%,(P<0.05);Ⅰ组出现1例感染;Ⅱ组出现2例感染,1例骨不连,但两组并发症发生率并无统计学差异(P=0.3380)。结论对于股骨干粉碎性骨折,闭合复位带锁髓内钉内固定术具有创伤小、出血量少、术后康复快等优势,但对于闭合复位困难者,有限切开复位术可缩短手术时间、准确复位,骨折愈合快。

Objective To observe the clinical curative effects of closed reduction and limited open reduction with intramedullary nail internal fixation in the treatment of comminuted femoral shaft fracture,and to discuss the selection of different reduction methods. Methods Retrospectively analyze the data of 36 cases of patients with comminuted femoral shaft fracture,the patients ever received treatment in our hospital during January 2012 and May 2015. The patients received closed reduction with intramedullary nail internal fixation were included in group I,and the patients received limited open reduction with intramedullary nail internal fixation were included in group II. The operation time,amount of intraoperative blood loss,postoperative complication,postoperative fracture healing time,and improvement in knee joint function were evaluated. Results The operation time of group Ⅰ（ 100.26.00±6.99 min） was longer than that of group II（ 94.06± 4.01 min）,and there was statistically significant differences（ t = 3.2114,P〈0.05）. Intraoperative blood loss of group Ⅰ was statistically less than group Ⅱ（ t = 14. 5887,P 0. 05）. Follow-up time of all patients ranged from 12 to 18 months. The postoperative fracture healing time of group Ⅰ was（ 9. 11 ± 1. 12） months,while it was（ 6. 59 ± 0. 96） months of group Ⅱ,the difference between the groups was statistically significant（ t = 7.2286,P 0. 05）. According to the Kotmert knee score standard,the excellent and good rate of keen function in group I（ 84.21%） was higher than that in group Ⅱ（ 64.70%）,and there was statistically significant differences（ P 0. 05）. There was one case of infection in group Ⅰ,and there were two cases of infection and one case of nerve injury in group Ⅱ,but there was no statistical difference between the two groups（ P = 0. 3380）. Conclusions For the comminuted femoral shaft fracture,the closed reduction with intramedullary nail internal fixation has the advantages of small trauma,less bleeding and quick recovery after operation. But for the femoral shaft fracture that is difficult to close reset,the limited open reduction can shorten the operation time,reset accurately and heal the fracture quickly.