附加侧方钢板手术对下肢骨折行髓内钉内固定术后骨不连患者的影响

Effect of Additional Lateral Plate Surgery on Patients with Bone Nonunion After Intramedullary Nail Fixation for Lower Limb Fracture

目的探讨附加侧方钢板手术(ALPS)对下肢骨折行髓内钉内固定术(INF)后骨不连患者的影响。方法选取2019年10月至2020年9月于安阳地区医院因下肢骨折行INF后骨不连患者150例。将患者按随机数表法分为ALPS组和髓内钉置换术(INR)组,各75例。INR组接受INR治疗,ALPS组接受ALPS治疗。比较两组围手术期情况(手术时间、术中出血量、住院时间、骨不连愈合时间)、术后恢复情况、膝关节功能(Johner-Wuhs评分)优良率、并发症发生率及生活质量[综合评定问卷-74(GQOL-74)]。结果与INR组比较,ALPS组手术时间、住院时间、骨不连愈合时间较短,术中出血量较少(P<0.05);ALPS组下肢缩短畸形率[2.67%(2/75)]、成角畸形率(0)较INR组[22.67%(17/75)、21.33%(16/75)]低,骨不连愈合率[97.33%(73/75)]较INR组[56.00%(42/75)]高(P<0.05);ALPS组Johner-Wuhs评分结果优良率[84.00%(63/75)]较INR组[62.67%(47/75)]高(P<0.05);ALPS组并发症发生率[1.33%(1/75)]较INR组[10.67%(8/75)]低(P<0.05)。术后6个月,ALPS组躯体功能、心理功能、社会功能、物质生活评分较INR组高(P<0.05)。结论ALPS应用于下肢骨折行INF后骨不连患者中可缩短手术和住院时间,减轻手术创伤,加快骨不连愈合,促进患者术后恢复,临床应用效果突出。

Objective To investigate the effect of additional lateral plate surgery(ALPS)on patients with bone nonunion after intramedullary nail fixation(INF)for lower limb fractures.Methods From October 2019 to September 2020,150 patients with bone nonunion after INF for lower limb fractures in Anyang District Hospital were selected.The patients were divided into ALPS group and INR group by the random number table method,with 75 cases in each group.The INR group received INR,and the ALPS group received ALPS.The perioperative conditions(operating time,intraoperative blood loss,hospitalization time,bone nonunion healing time),postoperative recovery,excellent and good rate of knee function(Johner-Wuhs score),complication rate and quality of life[generic quality of life inventory-74(GQOL-74)]were compared between the two groups.Results Compared with INR group,ALPS group had shorter operation time,hospitalization time,bone nonunion healing time and less intraoperative bleeding(P<0.05).The incidence of lower limb shortening deformity and angulation deformity in ALPS group[2.67%(2/75),0]was lower than that in INR group[22.67%(17/75),21.33%(16/75)],and the healing rate of bone nonunion[97.33%(73/75)]was higher than that in INR group[56.00%(42/75)](P<0.05).The excellent and good rate of Johner-Wuhs score in ALPS group was 84.00%(63/75),which was higher than that in INR group[62.67%(47/75)](P<0.05).The complication rate of ALPS group was 1.33%(1/75),which was lower than that of INR group[10.67%(8/75)](P<0.05).Six months after surgery,the scores of physical function,psychological function,social function and material life in ALPS group were higher than those in INR group(P<0.05).Conclusion The application of ALPS to patients with nonunion after INF for lower limb fractures can shorten the operation and hospitalization time,reduce surgical trauma,accelerate the healing of nonunion,and promote the recovery of patients after surgery.The clinical application effect is outstanding.