交锁髓内钉固定术治疗四肢创伤骨折后骨不连的疗效及对患者围术期指标和术后并发症的影响

Clinical Efficacy of Interlocking Intramedullary Nailing in Treatment of Patients with Bone Nonunion after Traumatic Fractures of Extremities and Its Effects on Perioperative Indexes and Postoperative Complications

目的研究交锁髓内钉固定术治疗四肢创伤骨折后骨不连的疗效及对患者围术期指标和术后并发症的影响。方法选择本院2017年1月—2019年5月诊治的四肢创伤骨折后骨不连102例为研究对象,按手术方式不同分为对照组53例和观察组49例。对照组给予加压钢板内固定术,观察组给予交锁髓内钉固定术。比较2组围术期指标、术后运动功能、生活质量和并发症情况,并评估手术效果。结果与术前比较,2组术后1 d皮质醇(Cor)、促肾上腺皮质激素(ACTH)水平升高,但观察组低于对照组(P<0.01)。观察组住院时间、术中出血量低于对照组(P<0.05)。观察组手术优良率显著高于对照组(P<0.05)。与术前相比,2组术后上下肢运动功能评分、Barthel指数和生活质量评分均显著上升,且观察组高于对照组(P<0.05)。2组术后并发症总发生率比较差异无统计学意义(P>0.05)。结论交锁髓内钉固定术治疗四肢创伤骨折后骨不连安全有效,可较好的促进围术期指标改善,减少术后并发症,促进患者恢复。

Objective To study clinical efficacy of interlocking intramedullary nailing in treatment of patients with bone nonunion after traumatic fractures of extremities and its effects on perioperative indexes and postoperative complications.Methods A total of 102 patients with bone nonunion after traumatic fractures of extremities who had been treated during January 2017 and May 2019 were divided into control group(n=53)and observation group(n=49)according to different surgical methods.Control group was treated with compression plate internal fixation,while observation group was treated with interlocking intramedullary nailing.Perioperative indexes,postoperative motor function,quality of life and incidence rate of complications were compared,and surgical results were evaluated in two groups.Results Compared with those before operation,preoperative cortisol(Cor)and adrenocorticotropic hormone(ACTH)levels were significantly higher in two groups,but the levels in observation group were significantly lower than those in control group(P<0.01),but levels of intraoperative volume of blood loss,length of hospital stay and postoperative Cor and ACTH levels in observation group were significantly lower than those in control group(P<0.05).The excellent and good rate of surgery in observation group was significantly higher than that in control group(P<0.05).Values of postoperative motor function scores,Barthel index and quality of life scores of upper and lower limbs were significantly increased compared with those before operation in two groups,and the values in observation group were significantly higher than those in control group(P<0.05).There was no statistically significant difference in total incidence rate of postoperative complications between two groups(P>0.05).Conclusion Interlocking intramedullary nailing in treatment of patients with bone nonunion after traumatic fractures of extremities is safe and effective,and it may well improve perioperative indexes,decrease postoperative complications and promote postoperative recovery.