单一蝶型骨折块移位程度对髓内钉治疗股骨干骨折愈合的影响

Effect of displacement degree of single butterfly fracture fragment on the healing of femoral shaft fracture treated with intramedullary nail

摘要:

目的： 探讨伴有单一蝶形骨折块的股骨干骨折使用髓内钉治疗后，骨折块的移位程度对骨折愈合的影响。方法： 回顾性分析2010年2月至2016年2月徐州医科大学附属连云港医院收治的闭合性股骨粉碎性骨折患者72例，其中男性46例，女性26例；平均年龄38（17~64）岁；右侧40例，左侧32例。所有患者均采用股骨交锁髓内钉治疗，参照股骨干直径，将蝶型骨折块移位程度分为4度：Ⅰ度（移位小于骨干直径的1/3）41例；Ⅱ度（移位大于骨干直径的1/3同时小于其2/3）17例；Ⅲ度（移位大于骨干直径的2/3）9例；Ⅳ度（骨折块翻转）5例。根据RUSF评分、骨折愈合率、骨折平均愈合时间评估骨折块的移位程度对骨折愈合的影响。结果： 4组患者各项指标比较均有统计学意义，其中Ⅰ度移位组患者骨折愈合情况最好，愈合率为87.8%，平均愈合时间为4.8个月，Ⅲ度移位组和Ⅳ度移位组愈合患者愈合情况最差，愈合率分别为22.2%和20.0%，平均愈合时间为12.6个月和18个月，Ⅱ度移位组患者愈合率为64.7%，平均愈合时间为8.9个月。结论： Ⅰ度移位的蝶型骨折块可以不用干预，Ⅳ度移位骨折块应使骨折块复位并尽可能贴近骨干骨缺损以避免出现骨不连，Ⅱ度和Ⅲ度移位的骨折块应尽可能使用闭合复位的操作使骨折块达到Ⅰ度移位的范围内以尽可能减少骨不连的发生率。

Abstract:

Objective: To investigate the effect of single butterfly fracture fragment on the healing of femoral shaft fracture treated with intramedullary nail. Methods: From February 2010 to February 2016, 72 patients with closed femoral comminuted fracture admitted to Xuzhou Medical University Affiliated Hospital of Lianyungang, including 46 males and 26 females, with an average age of 38 (17-64 years old), 40 cases on the right side, and 32 cases on the left side. All patients were treated with femoral interlocking intramedullary nail. According to femoral shaft diameter, the displacement degree of butterfly fracture was divided into four degrees: Ⅰdegree (displacement was less than 1/3 of shaft diameter): 41 cases; Ⅱdegree (displacement was greater than 1/3 of the diameter and less than 2/3): 17 cases; Ⅲdegree (displacement was greater than 2/3 of the diameter): 9 cases; Ⅳdegree (fracture fragment turnover): 5 cases. According to RUSF score, fracture healing rate and average time of fracture healing, the effect of displacement degree of fracture fragment on fracture healing was evaluated. Results: All the indexes of the 4 groups were statistically significant. The fracture healing was best in the group ofⅠdegree displacement, with the fracture healing rate of 87.8% and the average healing time of 4.8 months. The patients withⅢdegree displacement andⅣdegree displacement had the worst healing, and the healing rate was 22.2% and 20.0%, respectively, with an average healing time of 12.6 months and 18 months. The patients withⅡdegree displacement had the healing rate of 64.7% and the average healing time of 8.9 months. Conclusion: The butterfly fracture withⅠdegree displacement needs no intervention, the fracture withⅣdegree displacement should be restored and as close to the bone defect as possible to avoid nonunion, andⅡdegree andⅢdegree displaced fragments should be given closed reduction to withinⅠdegree displacement as far as possible to minimize the incidence of nonunion.