Injury:股骨髓内钉旋转不良与骨科医生经验无关

2014-07-04 超人也想当好医生 丁香园

股骨干骨折是最常见的长骨骨折,髓内钉固定是治疗的金标准。手术治疗的目标是恢复股骨的长度、骨折对位对线和股骨的形态。其中股骨形态是指在轴位面上股骨颈和股骨髁后侧所成角度,可衡量股骨旋转功能(正常人平均DFV为4°,只有5%超过11°)。 研究表明要达到上述治疗目标对创伤骨科医生来说充满挑战性,即使是经受过专业培训和有丰富经验的手术医师治疗后发生股骨旋转不良的几率仍较高。 而Liodaki

股骨干骨折是最常见的长骨骨折,髓内钉固定是治疗的金标准。手术治疗的目标是恢复股骨的长度、骨折对位对线和股骨的形态。其中股骨形态是指在轴位面上股骨颈和股骨髁后侧所成角度,可衡量股骨旋转功能(正常人平均DFV为4°,只有5%超过11°)。

研究表明要达到上述治疗目标对创伤骨科医生来说充满挑战性,即使是经受过专业培训和有丰富经验的手术医师治疗后发生股骨旋转不良的几率仍较高。

而Liodakis医生等关于髓内钉治疗股骨干骨折后发生旋转不良的研究没有证明发生旋转不良的危险因素,只说明了手术医生的经验不影响骨折治疗后的股骨形态。然而,受过专业培训的手术医生术中的一些关键步骤的处理可改善患者的预后。因此,Ormi B.Ayalon医生等进行了该研究,结果表明受过专业培训的医生治疗后的DFV与没有经过专业培训的无明显差异,文章最近发表在Injury上。

研究纳入了2000年到2009年间355名行髓内钉治疗的股骨干骨折(AO/OTA 32A-C)患者,分别由受过专业培训的骨科医生和没有受过专业培训的骨科医生治疗。

主要通过以下两种方法评估股骨旋转功能:(1)术前双侧股骨小转子轮廓的影像学图像;(2)Tornetta教授等使用的定量测试。双侧股骨形态的比较主要参考Dugdale教授提出的在CT扫描图像分析中的方法,由受过创伤骨科专业培训的手术医生进行评估。另外,通过标准单因素和多因素分析两组术后发生旋转不良的文献因素。

研究结果显示有80.3%(288/355)的骨折患者经受过创伤骨科专业培训的手术医生治疗(表1),术后平均DFV为8.7°,而另一组的平均DFV为10.7°(表3),但在多因素分析中,考虑到年龄、性别、受伤机制、开放性或闭合性骨折、AO分型Winquist创伤分型时,两组平均DFV无显著统计学意义。

而两组AO分型和Winquist创伤分型的股骨干骨折的比较也无明显统计学差异(表2)。手术医生的经验对两组术后的平均DFV无明显影响。另外,两组的股骨旋转不良的比例(DFV>15°)无显著统计学意义(表3)。

表1:患者基本资料


表2:两组患者受伤严重程度的比例

表3:平均DFV和DFV>15°的比例

因此,作者认为受过创伤骨科专业培训的手术医生与非专业培训的手术医生行髓内钉固定治疗股骨干骨折,术后股骨形态(DFV)和股骨旋转不良(DFV>15°)的比例无明显差异。

原始出处:

Ayalon OB1, Patel NM1, Yoon RS1, Donegan DJ2, Koerner JD3, Liporace FA4.Comparing femoral version after intramedullary nailing performed by trauma-trained and non-trauma trained surgeons: is there a difference?Injury. 2014 Jul;45(7):1091-4. doi: 10.1016/j.injury.2014.01.024. Epub 2014 Jan 30.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1877886, encodeId=8b2718e7886ee, content=<a href='/topic/show?id=d21b9864ab' target=_blank style='color:#2F92EE;'>#Injury#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9864, encryptionId=d21b9864ab, topicName=Injury)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8ba7103, createdName=xuqianhua, createdTime=Sun Jul 06 01:31:00 CST 2014, time=2014-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1506459, encodeId=6d68150645969, content=<a href='/topic/show?id=05c010210252' target=_blank style='color:#2F92EE;'>#髓内钉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102102, encryptionId=05c010210252, topicName=髓内钉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4cfc9759058, createdName=hanhaisha2011, createdTime=Sun Jul 06 00:31:00 CST 2014, time=2014-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1529651, encodeId=7bab152965137, content=<a href='/topic/show?id=70ff81e9156' target=_blank style='color:#2F92EE;'>#股骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81791, encryptionId=70ff81e9156, topicName=股骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9d3011964327, createdName=wangyang7962, createdTime=Sun Jul 06 00:31:00 CST 2014, time=2014-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1585247, encodeId=6fbb158524e62, content=<a href='/topic/show?id=e7fb101e8514' target=_blank style='color:#2F92EE;'>#骨科医生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101785, encryptionId=e7fb101e8514, topicName=骨科医生)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=413917143435, createdName=lvliquan, createdTime=Sun Jul 06 00:31:00 CST 2014, time=2014-07-06, status=1, ipAttribution=)]
    2014-07-06 xuqianhua
  2. [GetPortalCommentsPageByObjectIdResponse(id=1877886, encodeId=8b2718e7886ee, content=<a href='/topic/show?id=d21b9864ab' target=_blank style='color:#2F92EE;'>#Injury#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9864, encryptionId=d21b9864ab, topicName=Injury)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8ba7103, createdName=xuqianhua, createdTime=Sun Jul 06 01:31:00 CST 2014, time=2014-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1506459, encodeId=6d68150645969, content=<a href='/topic/show?id=05c010210252' target=_blank style='color:#2F92EE;'>#髓内钉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102102, encryptionId=05c010210252, topicName=髓内钉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4cfc9759058, createdName=hanhaisha2011, createdTime=Sun Jul 06 00:31:00 CST 2014, time=2014-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1529651, encodeId=7bab152965137, content=<a href='/topic/show?id=70ff81e9156' target=_blank style='color:#2F92EE;'>#股骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81791, encryptionId=70ff81e9156, topicName=股骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9d3011964327, createdName=wangyang7962, createdTime=Sun Jul 06 00:31:00 CST 2014, time=2014-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1585247, encodeId=6fbb158524e62, content=<a href='/topic/show?id=e7fb101e8514' target=_blank style='color:#2F92EE;'>#骨科医生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101785, encryptionId=e7fb101e8514, topicName=骨科医生)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=413917143435, createdName=lvliquan, createdTime=Sun Jul 06 00:31:00 CST 2014, time=2014-07-06, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1877886, encodeId=8b2718e7886ee, content=<a href='/topic/show?id=d21b9864ab' target=_blank style='color:#2F92EE;'>#Injury#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9864, encryptionId=d21b9864ab, topicName=Injury)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8ba7103, createdName=xuqianhua, createdTime=Sun Jul 06 01:31:00 CST 2014, time=2014-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1506459, encodeId=6d68150645969, content=<a href='/topic/show?id=05c010210252' target=_blank style='color:#2F92EE;'>#髓内钉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102102, encryptionId=05c010210252, topicName=髓内钉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4cfc9759058, createdName=hanhaisha2011, createdTime=Sun Jul 06 00:31:00 CST 2014, time=2014-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1529651, encodeId=7bab152965137, content=<a href='/topic/show?id=70ff81e9156' target=_blank style='color:#2F92EE;'>#股骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81791, encryptionId=70ff81e9156, topicName=股骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9d3011964327, createdName=wangyang7962, createdTime=Sun Jul 06 00:31:00 CST 2014, time=2014-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1585247, encodeId=6fbb158524e62, content=<a href='/topic/show?id=e7fb101e8514' target=_blank style='color:#2F92EE;'>#骨科医生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101785, encryptionId=e7fb101e8514, topicName=骨科医生)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=413917143435, createdName=lvliquan, createdTime=Sun Jul 06 00:31:00 CST 2014, time=2014-07-06, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1877886, encodeId=8b2718e7886ee, content=<a href='/topic/show?id=d21b9864ab' target=_blank style='color:#2F92EE;'>#Injury#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9864, encryptionId=d21b9864ab, topicName=Injury)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8ba7103, createdName=xuqianhua, createdTime=Sun Jul 06 01:31:00 CST 2014, time=2014-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1506459, encodeId=6d68150645969, content=<a href='/topic/show?id=05c010210252' target=_blank style='color:#2F92EE;'>#髓内钉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102102, encryptionId=05c010210252, topicName=髓内钉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4cfc9759058, createdName=hanhaisha2011, createdTime=Sun Jul 06 00:31:00 CST 2014, time=2014-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1529651, encodeId=7bab152965137, content=<a href='/topic/show?id=70ff81e9156' target=_blank style='color:#2F92EE;'>#股骨#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81791, encryptionId=70ff81e9156, topicName=股骨)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9d3011964327, createdName=wangyang7962, createdTime=Sun Jul 06 00:31:00 CST 2014, time=2014-07-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1585247, encodeId=6fbb158524e62, content=<a href='/topic/show?id=e7fb101e8514' target=_blank style='color:#2F92EE;'>#骨科医生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101785, encryptionId=e7fb101e8514, topicName=骨科医生)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=413917143435, createdName=lvliquan, createdTime=Sun Jul 06 00:31:00 CST 2014, time=2014-07-06, status=1, ipAttribution=)]