颜茂华　朱求亮　徐国荣　章学超浙江省安吉县人民医院骨科，浙江安吉　313300

恢复骨皮质完整性对促进股骨、胫骨粉碎性骨折愈合的疗效分析

颜茂华朱求亮徐国荣章学超
浙江省安吉县人民医院骨科，浙江安吉313300

目的 探讨在治疗粉碎性股骨、胫骨骨折时开放恢复骨皮质完整性和微创LISS钢板内固定的疗效。方法选择2012年12月～2014年12月我院手术治疗的股骨髁上粉碎性骨折、胫骨近端粉碎性骨折75例，随机分为两组，观察组39例，行切开复位尽可能恢复骨皮质完整性。对照组36例，行经皮微创钢板内固定。对比分析两组术后的骨折愈合时间及Merchan评分。采用Merchan评分评价治疗效果。 结果 手术顺利完成，均经6～24个月随访，观察组骨折愈合时间（16．2±3．4）周，对照组（16．2±3．0）周，两组骨折愈合时间比较差异无统计学意义（P＞0．05）；Merchan方法评分，观察组总优良率为87．18%，对照组总优良率为75.00%，两组差异有统计学意义（P＜0．05）。结论在治疗粉碎性骨折时恢复骨皮质完整性促进骨折愈合效果明显，但在操作上要遵循微创原则，减少剥离，保护血供。

恢复骨皮质完整性；粉碎性骨折；骨不愈合；骨折延迟愈合

[Abstract]Objective To explore the clinical efficacy for the treatment of comminuted femur and tibia fracture between the open recovering the integrity of bone cortex and the minimally invasive plate with less invasive stabilization system （LISS）.Methods From December 2012 to December 2014,A total of 75 patients suffering from comminuted fracture on femoral and proximal tibia were divided into two groups：39 cases in open recovering the integrity of bone cortex and 36 cases in mini incision approach,The postoperative Merchan score and the healing time of bone was recorded．The curative effect was compared according to Merchan score system.Results All cases were finished successfully,with the followed up 6-24 months,the healing times of bone was(16.2±3.4)weeks and(16.2±3.0)weeks,without significant difference（P＞0．05）．The postoperative Merchan Score was 87.18%and 75.00%,and there was significant difference between the two groups（P＜0．05）.Conclusion In terms of comminuted fracture treatment,recovering the integrity of bone cortex has a significant curative effect of promoting fracture healing，but the minimally-incisive principle reducing strip and protecting blood supply need to be followed.

[Key words]Recovery the integrity of bone cortex;Comminuted fracture;Nonunion;Delayed union of fractures

在临床工作中我们碰到很多股骨远端，胫骨近端粉碎性骨折，在遵循了微创、少剥离、保护骨折断端血供、弹性固定的治疗原则[1]后仍出现很多骨折延迟愈合、部分愈合或不愈合，一旦发生往往需行自体骨移植及更换内植物[2]，给患者带来更多的花费和痛苦。我院骨科自2012年12月～2014年12月采用一期术中尽可能恢复骨皮质完整性治疗39例股骨髁上、胫骨近端粉碎性骨折，取得了很好的治疗效果，现报道如下。……