摘要
目的 比较闭合复位和切开复位交锁髓内钉治疗闭合性股骨中段粉碎性骨折的临床疗效.方法 2001年12月至2012年2月,应用交锁髓内钉治疗闭合性股骨中段粉碎性骨折150 例,其中男114 例,女36 例,年龄18～68 岁,平均35.3 岁.按Winquist-Hansen分类,Ⅰ型35 例,Ⅱ型38 例,Ⅲ型40 例,Ⅳ型37 例.闭合复位76 例（A组）,切开复位自体骨移植74 例（B组）.对两组手术时间、术中出血量、骨折愈合时间、远期疗效等指标进行比较.结果 7 例失访,143 例获得随访,时间为6～21个月,平均9.3个月,术后无切口感染、内固定松动、断裂等并发症,A组中股骨颈骨折1 例,延迟愈合3 例,骨不连1 例,相应治疗后均骨性愈合;B组中延迟愈合2 例,未作特殊处理自行愈合.A组的手术时间、术中出血量均少于B组,差异有统计学意义（P＜0.05）,两组的骨折愈合时间无明显差异,远期疗效按马元璋功能评定标准评定,A组：优39 例,良27 例,可7 例,优良率90.41%;B组：优32 例,良28 例,可10 例,优良率85.71%,经统计两组优良率差异有统计学意义（P＜0.05）.结论 闭合复位交锁髓内钉治疗股骨中段粉碎性骨折,具有手术创伤小、对骨折端及骨块的血运干扰小、不破坏骨折处的血肿、早期进行功能锻炼、远期疗效好等优点,是一种理想的手术方法.但需要掌握手术时机,严格按照程序操作,密切术后随访,定期行影像学检查,及时发现和治疗相关并发症,尽早恢复肢体功能.
Objective To compare the clinical effects of closed reduction and open reduction with intramedullary nailing for closed and comminuted fractures of middle femur. Methods From December 2001 to February 2012,150 patients with closed and comminuted fractures of middle femur were treated with intramedullary nailing. They were divided into 2 groups ：76 cases were treated with closed reduction （group A） and 74 cases with open reduction and autogenous bone graft （group B）. We recorded and analyzed the following aspects：the operative time, the volume of blood losing, fracture healing time and the long-term results. Results 7 cases were lost during follow-up. 143 cases were followed-up for 6 months to 21 months with an average of 9.3 months. No complications such as incision infection,internal fixation loosening or breakage occurred. In group A, there were 1 case was with femoral neck fractures ,3 cases with delayed union and 1 case with nonunion. All the patients ob- tained osseous healing after treatment. In group B, 2 cases with delayed union healed without special treatment. The op- erative time and the volume of blood losingin group A were less than group B , and the differences were statistically significant （ P 〈 O. 05 ）. There was no obvious difference in the fracture healing time. According to MaYuan-zhang function evaluation the long- term results were excellent in 39 cases,good in 27 cases and fair in 7 cases,excellent and good rate was 90.41% in group A. And there were excellent in 32 cases,good in 28 cases and fair in 10 cases,excellent and good rate was 85.71% in group B, and the differences of excellent and good rate were statistically significant between two groups. （ P 〈 0.05 ）. Conclusion Closed reduction is characterized by minimal operative trauma, less interference for blood supply of fracture site and bone blocks, unbroken bematoma of fracture site, early recovering training and good long-term results in treatment of middle commi- nuted femoral fractures with intramedullary na
出处
《实用骨科杂志》
2013年第9期788-791,共4页
Journal of Practical Orthopaedics
关键词
股骨中段
粉碎骨折
闭合复位
髓内钉
middle comminuted femoral fractures
closed reduction
intramedullary nailing
