CAJ | 학술논문

目的：探讨阻挡螺钉改善股骨干中下段骨折顺行交锁髓内钉固定的效果，同时比较股骨顺行交锁髓内钉和逆行交锁髓内钉固定在治疗股骨干中下段骨折时对膝关节功能影响的差异。方法回顾分析2009年6月至2012年6月股骨干中下段骨折患者共52例。其中使用股骨顺行交锁髓内钉结合阻挡螺钉固定组患者28例，而在该组内部分患者是一期手术即加用阻挡螺钉，另一部分患者是二期增加阻挡螺钉固定。对照组使用逆行交锁髓内钉未采用阻挡螺钉固定组患者24例。所有患者术后随访12~20个月，对骨折愈合后患者膝关节功能进行Merchant评分测定。结果采用顺行交锁髓内钉结合阻挡螺钉固定的患者随访时间内骨折全部愈合，恢复良好。其中，一期手术未采用阻挡螺钉的患者，在改为动力化固定并加用阻挡螺钉后骨折断端的稳定性明显得到了改善，骨折的愈合加速。逆行交锁髓内钉未采用阻挡螺钉固定组患者出现关节腔内感染1例，后经冲洗引流后好转。2例患者术后出现关节内游离体。4例在其随访时间内骨折未愈合。其中3例断端出现硬化骨不连，再次手术更换髓内钉，并进行滑槽植骨，加用阻挡螺钉；另1例内固定断裂后再骨折，改用LISS钢板固定并植骨。研究发现，逆行髓内钉未采用阻挡螺钉组，手术并发症发生率远高于前组。同时我们对骨折愈合后的患者膝关节功能行Merchant评分，发现两组患者膝关节功能差异有统计学意义（P<0.05）。结论在治疗股骨干中下段骨折时，阻挡螺钉能改善顺行交锁髓内钉固定效果增加骨折断端固定的稳定性，促进骨折愈合。较逆行髓内钉固定相比，顺行髓内钉固定能避免对正常膝关节结构的破坏，保护膝关节功能，同时避免取内固定时膝关节的二次损伤。
목적：탐토조당라정개선고골간중하단골절순행교쇄수내정고정적효과，동시비교고골순행교쇄수내정화역행교쇄수내정고정재치료고골간중하단골절시대슬관절공능영향적차이。방법회고분석2009년6월지2012년6월고골간중하단골절환자공52례。기중사용고골순행교쇄수내정결합조당라정고정조환자28례，이재해조내부분환자시일기수술즉가용조당라정，령일부분환자시이기증가조당라정고정。대조조사용역행교쇄수내정미채용조당라정고정조환자24례。소유환자술후수방12~20개월，대골절유합후환자슬관절공능진행Merchant평분측정。결과채용순행교쇄수내정결합조당라정고정적환자수방시간내골절전부유합，회복량호。기중，일기수술미채용조당라정적환자，재개위동력화고정병가용조당라정후골절단단적은정성명현득도료개선，골절적유합가속。역행교쇄수내정미채용조당라정고정조환자출현관절강내감염1례，후경충세인류후호전。2례환자술후출현관절내유리체。4례재기수방시간내골절미유합。기중3례단단출현경화골불련，재차수술경환수내정，병진행활조식골，가용조당라정；령1례내고정단렬후재골절，개용LISS강판고정병식골。연구발현，역행수내정미채용조당라정조，수술병발증발생솔원고우전조。동시아문대골절유합후적환자슬관절공능행Merchant평분，발현량조환자슬관절공능차이유통계학의의（P<0.05）。결론재치료고골간중하단골절시，조당라정능개선순행교쇄수내정고정효과증가골절단단고정적은정성，촉진골절유합。교역행수내정고정상비，순행수내정고정능피면대정상슬관절결구적파배，보호슬관절공능，동시피면취내고정시슬관절적이차손상。
Objective To discuss the therapeutic effect of blocking screws, when they were used to improve femoral antegrade interlocking intra-medullary nail's fixation, and to compare different influence of the knee joint between femoral antegrade intra-medullary nail and retro-grade intra-medullary nail. Method From June 2009 to June 2012, we chosed 52 patients with femoral lower-middle section fracture. Among these patients, 28 cases were fixed with antegrade intra-medullary nails combined with blocking screws, some in one-stage operation and other in two-stage operation. 24 cases were fixed with retro-grade intra-medullary nails. All of these two groups’ patients were followed up for 12-20 months. Furthermore, their knee joint Merchant scores were assessed after bone fractures cured. Result Fractures of first group, who were received the fixation of antegrade intra-medullary nails combined with blocking screws, were all cured completely during the follow-up. Some two-stage operation patients, their fracture fixation were improved obviously after adopting blocking screws in motorization. But there were 4 cases in another group, whose fractures were still not healed during the follow-up.1 cases with infection in the knee joint, another 2 case with joint loose bodies. Surgical complication rate was far higher than the previous group. When the knee Merchant scores were assessed, statistical meaning was found between two groups' difference(P<0.05). Conclusion Blocking screws can improve antegrade intra-medullary nail fixation effect, increase the stability of fracture and promote the healing. Compared with retro-grade intra-medullary nail, antegrade intra-medullary nail can avoid the injury of knee normal structure and protect knee joint function.