髓内钉治疗伴有蝶形骨折块的股骨干骨折术中干预的疗效分析

Effect of Intraoperative Intervention in Intramedullary Nail Operation of Femoral Shaft Fracture with Butterfly Fragments

目的探讨髓内钉治疗股骨干骨折,术中干预Ⅱ度及以上移位的骨折块对股骨干骨折愈合的疗效。方法采用回顾性病例对照研究分析2016年2月至2020年2月连云港市第一人民医院收治的115例股骨干骨折伴蝶形骨折块患者临床资料,其中男58例,女57例;年龄17~68岁,平均(39.0±11.9)岁;右侧62例,左侧53例。致伤原因:车祸伤71例,高处坠落18例,骑车摔倒12例,压砸伤等其他14例。受伤到手术时间平均(5.0±2.4)d。根据是否术中干预蝶形骨折块,分为干预组:Ⅱ度移位患者34例,Ⅲ度移位患者14例,Ⅳ度移位患者11例;对照组:Ⅱ度移位患者30例,Ⅲ度移位患者16例,Ⅳ度移位患者10例。比较各组骨折愈合率、愈合时间、完全负重时间以及术后9个月的改良股骨X线愈合评分(modified radiological union scale for femur,mRUSF)。结果术后115例患者均获随访,随访时间9~24个月,平均(15.2±3.8)个月。在Ⅱ度移位病例中,干预组的骨折愈合率、愈合时间、完全负重时间以及术后9个月的mRUSF评分均优于对照组(P<0.05);在Ⅲ度移位病例中,干预组的骨折愈合率、愈合时间、完全负重时间以及术后9个月的mRUSF评分均优于对照组(P<0.05);在Ⅳ度移位病例中,干预组的骨折愈合率、完全负重时间以及术后9个月的mRUSF评分优于对照组(P<0.05)。结论髓内钉治疗股骨干骨折,术中对Ⅱ度、Ⅲ度、Ⅳ度移位的骨折块进行干预,减小骨折块移位程度至Ⅰ度,有利于股骨骨折愈合。

Objective To investigate the effect of intramedullary nail on femoral shaft fracture healing by intervening the displaced fracture fragments with degreeⅡand above during operation.Methods A retrospective case-control study was conducted to analyze the clinical data of 115 patients with femoral shaft fracture with butterfly fracture admitted to the First People's Hospital of Lianyungang from February 2016 to February 2020,including 58 males and 57 females,62 right and 53 left.The age ranged from 17 to 68 years,with an average of(39.0±11.9)years.There were 71 cases of a traffic accident,18 cases of a fall from height,12 cases of a cycling fall,14 cases of crushing or other according to the cause of injury.The time from injury to surgery was(5.0±2.4)days.According to whether butterfly fracture fragments were intervened during surgery,patients were divided into the intervention group and control group.Interention group had 34 patients with gradeⅡdisplacement,14 patients with gradeⅢdisplacement and 11 patients with gradeⅣdisplacement.The control group had 30 patients with gradeⅡdisplacement,16 patients with gradeⅢdisplacement,and 10 patients with gradeⅣdisplacement.The fracture healing rate,healing time,full weight-bearing time,and the modified Radiological Union Scale for Femur(mRUSF)at 9 months at 9 months after surgery were compared between the groups.Results All 115 patients were followed up for 9~24 months,with an average of(15.2±3.8)months.In cases of gradeⅡdisplacement,the fracture healing rate,healing time,full weight-bearing time,and mRUSF score at 9 months after surgery in the control group were superior to those in the intervention group(P<0.05).In cases of gradeⅢdisplacement,the fracture healing rate,healing time,full weight-bearing time,and mRUSF score at 9 months after surgery in the control group were superior to those in the intervention group(P<0.05).In cases of gradeⅣdisplacement,the fracture healing rate,full weight-bearing time,and mRUSF score at 9 months after surgery in the control group were superior to those in the intervention group(P<0.05).Conclusion During the treatment of femoral shaft fractures with intramedullary nails,intraoperative intervention should be used on the displaced fragments of gradeⅡ,Ⅲ,and IV to reduce the degree of fragment displacement to gradeⅠ,which is beneficial to femoral fracture healing.