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[摘要] 目的 探討微创手术方法治疗老年四肢骨折的临床治疗效果及对肢体功能的影响。 方法 选取2012年12月~2015年12月我院收治老年四肢骨折患者220例作为研究对象,根据随机数字表法分为对照组(n=110)和观察组(n=110)。对照组采用切开复位有限接触加压钢板治疗,观察组采用微创经皮钢板内固定(MIPPO)治疗,记录两组围术期指标,采用Harris评分对两组治疗后肢体功能进行评估,比较两组围术期指标、肢体功能及并发症发生率情况。 结果 观察组患者的手术、住院时间及术后骨折愈合时间明显比对照组短(P<0.05);观察组患者在手术期间的出血量明显比对照组少(P<0.05);两组患者在手术前Harris评分无明显差异(P>0.05);术后6个月、12个月、18个月三次对观察组患者Harris评分比对照组明显增高(P<0.05)。术后18个月观察组患者出现并发症的比率为1.82%,而对照组患者出现并发症的比率为8.18%,两组间存在明显差异(P<0.05)。结论 使用微创经皮钢板内固定治疗老年患者的四肢骨折,能明显提高患肢功能,临床效果好,值得广泛应用。
[关键词] 微创手术;四肢骨折;肢体功能
[中图分类号] R683.4 [文献标识码] B [文章编号] 1673-9701(2018)10-0080-04
Clinical effect of minimally invasive surgery in the treatment of senile limb fractures and its impact on limb function
CHEN Lei
Department of Orthopedics,the First Affiliated Hospital of the Medical College, Shihezi University, Shihezi 832000,China
[Abstract] Objective To investigate the clinical effect of minimally invasive surgery on the treatment of limb fractures in the elderly and its effect on the function of limbs. Methods Totally 220 elderly patients with limb fractures in our hospital from December 2012 to December 2015 were selected as study subjects and were randomly divided into control group(n=110)and observation group(n=110). The control group was treated with open reduction and limited contact and compression plate. The observation group was treated with minimally invasive percutaneous plate osteosynthesis(MIPPO). The perioperative parameters of two groups were recorded. Harris score was used to evaluate the limb function after treatment. Perioperative parameters, limb function and the incidence of complications were compared between the two groups. Results The operation time, hospital stay and fracture healing time in the observation group was significantly shorter than that in the control group(P<0.05). The intraoperative bleeding volume in the observation group was significantly less than that in the control group(P<0.05). There was no significant difference in the Harris scores between the two groups before surgery(P>0.05). Harris scores of patients in the observation group at 6 months, 12 months, 18 months after surgery were significantly higher than those in the control group(P<0.05). The incidence of complications in the observation group was 1.82% at 18 months after surgery, while the incidence of complications in the control group was 8.18%. There was a significant difference between the two groups(P<0.05). Conclusion Minimally invasive percutaneous plate osteosynthesis for the treatment of limb fractures in elderly patients can significantly improve limb function and has good clinical effect, which is worthy of widely application. 综上所述,使用微创经皮钢板内固定技术治疗四肢骨折的老年患者能有效改善患者的临床症状,大幅度提高患肢功能,减少术中出血量和并发症发生率,临床效果好,值得广泛应用。
[参考文献]
[1] 陈鹏,田晓滨. 切开复位内固定与微创经皮钢板接骨术治疗复杂肱骨近端骨折的疗效比较[J]. 中华创伤骨科杂志,2016,18(7):592-596.
[2] 应霁翀,刘观燚,张勇,等. 三种不同内固定方式治疗股骨转子间骨折术后隐性失血及血栓形成的比較[J]. 中华创伤骨科杂志,2016,18(5):442-446.
[3] 唐炜东. 前、后路不同手术方式治疗严重腰椎不稳定型骨折临床疗效分析[J]. 中国现代医学杂志,2015,25(6):56-60.
[4] 王卫东,王裕祥,王永虎, 等. 不同手术方法治疗老年股骨粗隆间骨折临床特点对比[J]. 中国老年学, 2015, 35(18):5239-5241.
[5] 贾建波,禹宝庆,吴良浩. 微创SuperPath入路人工股骨头置换术治疗老年股骨颈骨折的近期疗效[J]. 中华创伤骨科杂志,2016,18(11):938-944.
[6] 胡冰,张明勇,王勇. 两种手术方式对胫骨平台骨折患者围术期机体综合应激状态的影响比较[J]. 中国内镜杂志, 2015,21(7):700-702.
[7] 周杨,张玉良,陆建强,等. 70岁及以上患者股骨颈骨折手术及非手术治疗方法的疗效分析[J]. 中华老年医学杂志,2016,35(6):626-628.
[8] 王立强,李洋,刘成刚,等. 老年股骨颈骨折患者关节置换术后病死率及危险因素分析[J]. 中华医学杂志,2015, 95(11):832-835.
[9] 朱文煜,王颜,舒刚,等. 多发肋骨骨折并发创伤性膈疝患者的微创手术效果研究[J]. 中国内镜杂志, 2016, 22(8):74-78.
[10] 张培,高增鑫,吴小涛. Sextant经皮微创脊柱内固定系统治疗胸腰椎骨折的疗效研究[J]. 中国矫形外科杂志,2015,23(20):1831-1835.
[11] 胡安文,李锋,蒲丹,等. 不同方法治疗脊柱骨折伴硬脊膜损伤术后脑脊液漏的疗效比较[J]. 中华创伤杂志,2015,31(1):26-30.
[12] Zhang Kunmu,Li Changhui,Wang Shizhong,et al. A study of the influence of Guizhi plus Gegen Decoction on the mechanism of signal transductions occurring in cervical intervertebral disc cells of adult rats[J]. Biomedical Research, 2014,25(4):620-625.
[13] 龚永清,程丹萍. 微创下内固定术治疗上肢骨折的临床疗效[J]. 中国现代医生,2017, 55(12):74-76.
[14] 冯彬,何滨. 微创内固定系统治疗股骨远端骨折疗效分析[J]. 中国现代医生,2015,53(5):59-61.
[15] 周雁,黄伟,赵尹松. 锁定加压钢板联合打压植骨治疗肱骨近端骨折效果分析[J]. 现代实用医学,2016,28(6):718-720.
[16] 王小军. 上肢骨折32 例给予微创钢板内固定术治疗的效果观察[J]. 中国继续医学教育,2016,8(13):101-102.
(收稿日期:2017-10-27)
[关键词] 微创手术;四肢骨折;肢体功能
[中图分类号] R683.4 [文献标识码] B [文章编号] 1673-9701(2018)10-0080-04
Clinical effect of minimally invasive surgery in the treatment of senile limb fractures and its impact on limb function
CHEN Lei
Department of Orthopedics,the First Affiliated Hospital of the Medical College, Shihezi University, Shihezi 832000,China
[Abstract] Objective To investigate the clinical effect of minimally invasive surgery on the treatment of limb fractures in the elderly and its effect on the function of limbs. Methods Totally 220 elderly patients with limb fractures in our hospital from December 2012 to December 2015 were selected as study subjects and were randomly divided into control group(n=110)and observation group(n=110). The control group was treated with open reduction and limited contact and compression plate. The observation group was treated with minimally invasive percutaneous plate osteosynthesis(MIPPO). The perioperative parameters of two groups were recorded. Harris score was used to evaluate the limb function after treatment. Perioperative parameters, limb function and the incidence of complications were compared between the two groups. Results The operation time, hospital stay and fracture healing time in the observation group was significantly shorter than that in the control group(P<0.05). The intraoperative bleeding volume in the observation group was significantly less than that in the control group(P<0.05). There was no significant difference in the Harris scores between the two groups before surgery(P>0.05). Harris scores of patients in the observation group at 6 months, 12 months, 18 months after surgery were significantly higher than those in the control group(P<0.05). The incidence of complications in the observation group was 1.82% at 18 months after surgery, while the incidence of complications in the control group was 8.18%. There was a significant difference between the two groups(P<0.05). Conclusion Minimally invasive percutaneous plate osteosynthesis for the treatment of limb fractures in elderly patients can significantly improve limb function and has good clinical effect, which is worthy of widely application. 综上所述,使用微创经皮钢板内固定技术治疗四肢骨折的老年患者能有效改善患者的临床症状,大幅度提高患肢功能,减少术中出血量和并发症发生率,临床效果好,值得广泛应用。
[参考文献]
[1] 陈鹏,田晓滨. 切开复位内固定与微创经皮钢板接骨术治疗复杂肱骨近端骨折的疗效比较[J]. 中华创伤骨科杂志,2016,18(7):592-596.
[2] 应霁翀,刘观燚,张勇,等. 三种不同内固定方式治疗股骨转子间骨折术后隐性失血及血栓形成的比較[J]. 中华创伤骨科杂志,2016,18(5):442-446.
[3] 唐炜东. 前、后路不同手术方式治疗严重腰椎不稳定型骨折临床疗效分析[J]. 中国现代医学杂志,2015,25(6):56-60.
[4] 王卫东,王裕祥,王永虎, 等. 不同手术方法治疗老年股骨粗隆间骨折临床特点对比[J]. 中国老年学, 2015, 35(18):5239-5241.
[5] 贾建波,禹宝庆,吴良浩. 微创SuperPath入路人工股骨头置换术治疗老年股骨颈骨折的近期疗效[J]. 中华创伤骨科杂志,2016,18(11):938-944.
[6] 胡冰,张明勇,王勇. 两种手术方式对胫骨平台骨折患者围术期机体综合应激状态的影响比较[J]. 中国内镜杂志, 2015,21(7):700-702.
[7] 周杨,张玉良,陆建强,等. 70岁及以上患者股骨颈骨折手术及非手术治疗方法的疗效分析[J]. 中华老年医学杂志,2016,35(6):626-628.
[8] 王立强,李洋,刘成刚,等. 老年股骨颈骨折患者关节置换术后病死率及危险因素分析[J]. 中华医学杂志,2015, 95(11):832-835.
[9] 朱文煜,王颜,舒刚,等. 多发肋骨骨折并发创伤性膈疝患者的微创手术效果研究[J]. 中国内镜杂志, 2016, 22(8):74-78.
[10] 张培,高增鑫,吴小涛. Sextant经皮微创脊柱内固定系统治疗胸腰椎骨折的疗效研究[J]. 中国矫形外科杂志,2015,23(20):1831-1835.
[11] 胡安文,李锋,蒲丹,等. 不同方法治疗脊柱骨折伴硬脊膜损伤术后脑脊液漏的疗效比较[J]. 中华创伤杂志,2015,31(1):26-30.
[12] Zhang Kunmu,Li Changhui,Wang Shizhong,et al. A study of the influence of Guizhi plus Gegen Decoction on the mechanism of signal transductions occurring in cervical intervertebral disc cells of adult rats[J]. Biomedical Research, 2014,25(4):620-625.
[13] 龚永清,程丹萍. 微创下内固定术治疗上肢骨折的临床疗效[J]. 中国现代医生,2017, 55(12):74-76.
[14] 冯彬,何滨. 微创内固定系统治疗股骨远端骨折疗效分析[J]. 中国现代医生,2015,53(5):59-61.
[15] 周雁,黄伟,赵尹松. 锁定加压钢板联合打压植骨治疗肱骨近端骨折效果分析[J]. 现代实用医学,2016,28(6):718-720.
[16] 王小军. 上肢骨折32 例给予微创钢板内固定术治疗的效果观察[J]. 中国继续医学教育,2016,8(13):101-102.
(收稿日期:2017-10-27)