【作者】 李德；

【导师】 丁真奇；

【作者基本信息】 福建中医药大学 ， 中医骨伤科学， 2010， 硕士

【摘要】 目的：比较椎间盘镜辅助下和传统切开直视下逆行交锁髓内钉治疗股骨远端骨折的临床疗效,评价椎间盘镜辅助下逆行交锁髓内钉治疗股骨远端型骨折的可行性。方法：将2008年04月-2008年12月符合纳入标准和排除标准的所有患者按照随机数字表分为两组。其中单号患者采用椎间盘镜辅助下逆行交锁髓内钉内固定,双号患者采用传统切开直视下逆行交锁髓内钉内固定。手术后即开始CPM被动屈伸功能锻炼及主动股四头肌收缩功能锻炼。同时进行临床疗效评估。评测的指标包括：手术时间、术中出血量、住院天数、骨折愈合时间、膝关节Lysholm评分以及Kolment膝关节评分。应用SPSS 16.0统计软件包对所有数据进行统计分析。计量资料的比较先进行正态性检验和方差齐性检验,满足要求者采用两独立样本t检验,P<0.05为差异有统计学意义；若不符合正态分布,采用Mann-Whitney U检验。计数资料的比较,采用x2和Mann-WhitneyU检验检验；P<0.05表示差异显著。结果：纳入本研究的患者共有62例,椎间盘镜组32例和传统切开组30例。经统计学分析检验,两组平均年龄、性别、骨折类型、致伤原因、受伤至手术的时间及外伤的类型的差异均无统计学意义(P>0.05)。所有患者均至少回访12个月(随访时间12-15个月,平均13.4个月)。椎间盘镜组：手术时间平均96.59±14.28分钟；平均手术出血量125.31±27.71ml；平均住院时间11.47±1.83天；27例骨折正常愈合,3例延迟愈合,2例畸形愈合,平均骨折愈合时间112.25±52.93天。膝关节功能按Kolment评定标准,术后1个月的优良率为78.13%,术后3个月的优良率为87.5%,术后12个月的优良率为90.63%。膝关节Lysholm评分结果,术后3个月为77.09±14.15分,术后12个月为95.53±3.37分。切开组：手术时间平均115.50±18.02分钟；平均手术出血量179.98±30.83ml；平均住院时间15.83±2.05天；25例骨折正常愈合,2例延迟愈合,3例畸形愈合,平均骨折愈合时间108.70±47.58天,轻度钉尾撞击症3例,关节积液疼痛4例。膝关节功能按Kolment评定标准,术后1个月的优良率为53.3%,术后3个月的优良率为63.3%,术后12个月的优良率为70%。膝关节Lysholm评分结果,术后3个月为66.37±12.84分,术后12个月为86.43±4.72分。两组患者均未出现神经血管损伤、感染、内固定松动及断裂等相关并发症。两组在骨折愈合时间及骨折愈合情况上无明显差异(P>0.05)。两组随访时的手术时间、术中出血量、住院时间、Kolment评分、Lysholm评分,两组间差异有显著性(P<0.05)。结论：椎间盘镜辅助下股骨逆行交锁髓内钉治疗股骨远端骨折有更多的优势。如：更小的创伤、更少的失血量和更少的并发症,对于患者膝关节功能的早期恢复大有益处。更多还原

【Abstract】 Objective To compare clinical effect of microendoscopic-assited retrograde interlocking nailing (MPRIN) for fracture of distal femur with those of conventional open retrograde interlocking nailing (ORIN), and to determine whether MPRIN would be sufficient for fracture of distal femur.Methods From Feb.2008 to Dec.2008, All the patients who met the inclusion criteria and exclusion criteria were divided into two group according to table of random number. The patients who were odd numbers were treated with the MPRIN and those who were even number were treated with the ORIN. Knee joint continuous passive motion and musculus quadriceps fexoris initiative contraction exercises were allowed by the patients postoperatively.The evaluation was carried out in the postoperative period, and surgical time, blood loss, hospital stay, time of bone union, Lysholm Scores and Knee function assessment standards results by Kolment were recorded. Using SPSS 16.0 statistic software to deal with all the data and make 0.05 the boundary of statistical significance.Measurement datas were compared with two independent sample t test and Mann-Whitney U test, Count datas were compared with theχ2 test and Mann-Whitney U test.Results There were 62 pations included in this study. Group MPRIN had 32 pations and group had 30 pations. There were no significant difference of the average age, sex, fracture type, injury cause, time from injury to surgery or the type of trauma between the two groups (all p values>0.05). All patients were followed up retrospectively for at least 12 months (mean,13.4 months; range,12-15months) to compare the clinical results between the MPRIN and the ORIN.Group MPRIN:The average operative time was 96.59±14.28 minutes, and the average blood loss was 125.31±27.71ml, the average hospital stay was 11.47±1.83 days. All the fractures were united on an average of 103.34±25.35 days postoperatively except three pations who were delayed union and two pations who were malunion. Function of the knee was assessed by Kolment evaluation standards, excellent and good rate of the MPRIN was 78.13% at 1 months postoperatively,87.5% at 3months postoperatively,90.63% at 12 months postoperatively. According to Lysholm rating scales, the MPRIN was 77.09±14.15 at 3 months postoperatively,95.53±3.37 at 12 months postoperatively.Group ORIN:The average operative time was 115.50±18.02 minutes, and the average blood loss was 179.98±30.83ml, the average hospital stay was 15.83±2.05 days. All the fractures were united on an average of 102.03±23.04 days postoperatively except two pations who were delayed union, two pations who were malunion, three pations had nail tail Impingement,four pations had effusion of joint.No injuries of nerves and vessels, infection,no breakage or loosing of internal fixation instruments occurred in the two group. Function of the knee was assessed by Kolment evaluation standards, excellent and good rate of the MPRIN was 53.3% at 1 months postoperatively,63.3% at 3months postoperatively, 70% at 12 months postoperatively. According to Lysholm rating scales, the MPRIN was66.37±12.84 at 3 months postoperatively,86.43±4.72 at 12 months postoperatively.There were no significant difference of time of bone union between the two groups (all p values>0.05). There were ignificant difference of surgical time, blood loss, hospital stay, time of bone union, Lysholm Scores and Knee function assessment standards results between the two groups(all p values<0.05).Conclusion Fracture of distal femur treated with microendoscopic-assited percutaneous retrograde interlocking nailing is proved to have many advantages,such as less trauma and blood loss, accurate inserting the nailing, and less complications, are beneficial to functional revovery of the knee.更多还原