| 不同固定方法治疗青少年胫骨骨折的比较 |
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Received:January 20, 2014
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| 作者 | Author | 单位 | Unit | E-Mail |
| 余洋 |
YU Yang |
温州医科大学附属第二医院骨科, 浙江 温州 325027 |
Department of Orthopaedics, the Second Affiliated Hospital, Wenzhou Medical University, Whenzhou 325027, Zhejiang, China |
15052959@qq.com |
| 余可和 |
YU Ke-he |
温州医科大学附属第二医院骨科, 浙江 温州 325027 |
Department of Orthopaedics, the Second Affiliated Hospital, Wenzhou Medical University, Whenzhou 325027, Zhejiang, China |
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| 陈莹 |
CHEN Ying |
温州医科大学附属第二医院骨科, 浙江 温州 325027 |
Department of Orthopaedics, the Second Affiliated Hospital, Wenzhou Medical University, Whenzhou 325027, Zhejiang, China |
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| 周一飞 |
ZHOU Yi-fei |
温州医科大学附属第二医院骨科, 浙江 温州 325027 |
Department of Orthopaedics, the Second Affiliated Hospital, Wenzhou Medical University, Whenzhou 325027, Zhejiang, China |
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| 卢晓郎 |
LU Xiao-lang |
温州医科大学附属第二医院骨科, 浙江 温州 325027 |
Department of Orthopaedics, the Second Affiliated Hospital, Wenzhou Medical University, Whenzhou 325027, Zhejiang, China |
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| 洪建军 |
HONG Jian-jun |
温州医科大学附属第二医院骨科, 浙江 温州 325027 |
Department of Orthopaedics, the Second Affiliated Hospital, Wenzhou Medical University, Whenzhou 325027, Zhejiang, China |
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| 陈华 |
CHEN Hua |
温州医科大学附属第二医院骨科, 浙江 温州 325027 |
Department of Orthopaedics, the Second Affiliated Hospital, Wenzhou Medical University, Whenzhou 325027, Zhejiang, China |
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| 郭晓山 |
GUO Xiao-shan |
温州医科大学附属第二医院骨科, 浙江 温州 325027 |
Department of Orthopaedics, the Second Affiliated Hospital, Wenzhou Medical University, Whenzhou 325027, Zhejiang, China |
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| 期刊信息：《中国骨伤》2014年27卷，第10期，第874-877页 |
| DOI：10.3969/j.issn.1003-0034.2014.10.018 |
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目的：通过对3种固定方法的疗效及并发症比较并研究其有关影响因素，探讨治疗青少年胫骨骨折固定方式的选择。
方法：2007年1月至2012年1月收治青少年胫骨骨折患者79例（83处骨折），男55例，女24例；年龄11～17.6岁，平均13.9岁。分别采用弹性髓内钉、钢板及外固定支架进行固定治疗，并行回顾性分析。观察比较各组住院时间、骨折愈合时间以及并发症发生率和再手术发生率等。
结果：所有患者得到随访，平均随访时间为15.8个月。骨折愈合时间与固定方式、高能量损伤、多发骨折、开放性骨折因素显着相关。且外固定支架组愈合时间明显长于弹性髓内钉组和钢板组。外固定支架组并发症发生率明显高于弹性髓内钉组和钢板组。4例弹性髓内钉固定患者需再手术（复位丢失2例、延迟愈合和畸形愈合各1例）.6例外固定支架患者需再手术（复位丢失3例，畸形愈合2例，钉道感染1例）.2例钢板固定患者因不愈合、成角畸形行二次手术。通过统计学分析：外固定支架与弹性髓内钉固定术比较有7.56倍（95%可信区间=3.74～29.87）的复位丢失和（或）畸形愈合风险。末次随访时，3组疗效结果差异无统计学意义（P>0.05）.
结论：不同方法治疗青少年胫骨干骨折中，外固定支架固定术并发症发生率最高，弹性髓内钉可以达到其他固定系统效果并可避免大部分并发症，手术方式选择取决于医生的经验以及患者基本情况和骨折类型。 |
| [关键词]:青少年 胫骨骨折 骨折固定术，内 病例对照研究 |
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| Comparison of three fixation methods for the treatment of tibial fractures in adolescents |
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Abstract:
Objective: To explore the fixation methods in treatment of tibial fracture in adolescents by comparing the results and complications of three fixation methods and to determine the factors related to those complications.
Methods: From January 2007 to January 2012,83 diaphyseal tibial fractures in 79 adolescents were treated with elastic stable intramedullary nail fixation,plate fixation,or external fixation respectively. There were 55 males and 24 females with an average age of 13.9 years (ranging from 11 to 17.6 years). Outcomes were compared in terms of the hospital stay,time to union,complications,and reoperation rates.
Results: All patients were followed up for 15.8 months in average. The time to union was significant associated with the pattern of fixation,energy of the injury,multiple and open fracture. The time of bone union of external fixation group was longer than that of elastic stable intramedullary nail fixation and plate fixation groups. But complication rates of external fixation group were higher than that of elastic stable intramedullary nail fixation and plate fixation groups. Four patients were treated with elastic nail fixation underwent a reoperation (loss of reduction in 2 cases,delayed union and nonunion in each 1 case). Six patients were treated with external fixation required a reoperation (loss of reduction in 3 cases,malunion in 2 cases,and replacement of a pin canal infection in 1 case). Two fractures were treated with plate fixation required refixation following nonunion and malunion. A multivariate analysis with adjustment for baseline differences showed external fixation to be associated with a 7.56 times (95% confidence interval=3.74 to 29.87) greater risk of loss of reduction and (or) malunion than elastic stable intramedullary nail fixation. At the final follow-up,there were agreeable results among three groups and no significant differences among them in final therapeutic effect (P>0.05).
Conclusion: External fixation for treatment of tibial fracture in adolescents has the highest rate of complications than the other two fixation methods. Elastic stable intramedullary nail fixation can achieve the same effect of other fixed system and avoid most of the complications. Operation method choice depends on the experience of doctors and patients' basic situation and the fracture types. |
| KEYWORDS:Adolescent Tibial fractures Fracture fixation,internal Case-control studies |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 余洋,余可和,陈莹,周一飞,卢晓郎,洪建军,陈华,郭晓山.不同固定方法治疗青少年胫骨骨折的比较[J].中国骨伤,2014,27(10):874~877 |
| 英文格式: | YU Yang,YU Ke-he,CHEN Ying,ZHOU Yi-fei,LU Xiao-lang,HONG Jian-jun,CHEN Hua,GUO Xiao-shan.Comparison of three fixation methods for the treatment of tibial fractures in adolescents[J].zhongguo gu shang / China J Orthop Trauma ,2014,27(10):874~877 |
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