不同内固定方式在股骨干闭合性骨折切开复位内固定治疗中的临床效果

Clinical effect of different internal fixation methods in open reduction and internal fixation treatment of closed femoral shaft fractures

目的探讨不同内固定方式在股骨干闭合性骨折切开复位内固定治疗中的临床效果。方法选取2012年1月至2018年12月太仓市中医医院骨科病区单侧闭合性股骨干骨折行切开复位内固定术患者44例。根据内固定方式分为A组/钢板组(20例)、B组/单纯髓内钉组(14例)、C组/髓内钉结合辅助钢板组(10例)。比较三组手术时间、术中出血量、断端切口长度、临床愈合时间、膝关节HSS评分、畸形愈合率、临床愈合率。结果三组术中出血量、临床愈合时间比较,差异无统计学意义(P>0.05)。A组、B组手术时间短于C组,差异有统计学意义(P<0.05)。B组、C组断端切口长度短于A组,差异有统计学意义(P<0.05)。A组、C组膝关节HSS评分高于B组,差异有统计学意义(P<0.05)。三组畸形愈合率比较,差异无统计学意义(P>0.05)。B组骨折临床愈合率显著低于A组、C组,差异有统计学意义(P<0.05)。结论股骨干闭合性骨折行切开复位内固定手术,钢板组、髓内钉结合辅助钢板组较单纯髓内钉组具有更高的骨折愈合率,术后膝关节功能恢复好,推荐使用。

Objective To explore the clinical effects of different methods of internal fixation in open reduction and internal fixation for closed femoral shaft fractures.Methods A total of 44 cases of unilateral closed femoral shaft fractures who underwent open reduction and internal fixation in the orthopedic ward of the Taicang Hospital of Traditional Chinese Medicine from January 2012 to December 2018 were selected.They were divided into group A/the plate group(20 cases),group B/simple intramedullary nail group(14 cases),group C/intramedullary nail combined with auxiliary plate group(10 cases)according to the method of internal fixation.The operation time,intraoperative blood loss,length of fracture end incision,clinical fracture healing time,knee HSS score,malunion rate,clinical fracture healing rate were compared among the three groups.Results There were no statistically significant differences between the three groups in terms of average intraoperative blood loss and average clinical healing time(P>0.05).The operation times were shorter in group A and group B than in group C,the differences were statistically significant(P<0.05).The incision length of the fracture end were shorter in group B and group C than in group A,the differences were statistically significant(P<0.05).The knee HSS scores of group A and group C were higher than that of group B,the differences were statistically significant(P<0.05).The differences of abnormal healing rate between the three groups were not statistically significant(P>0.05).The clinical fracture healing rate in group B were statistically significant lower than that of goup A and gooup C(P<0.05).Conclusion The plate group and the intramedullary nail combined with the auxiliary plate group have a higher fracture healing rate and better knee joint function recovery than the intramedullary nail group in open reduction and internal fixation surgery for closed femoral shaft fractures.So these methods are more recommended.