两种不同可吸收髓内钉治疗掌骨和指骨骨折的对比研究

Huang Chaotong, Li Jingkuang, Zhu Jiakai, Li Pingyu, Xie Guangzhong, Gong Yuanhong

Department of Microsurgery, Houjie Hospital of Dongguan, Dongguan Guangdong 523945, PR China.

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2004 Sep;18(5):360-3.

OBJECTIVE

To study the effect of two different absorbable intramedullary nails in treatment of metacarpal and phalanx fractures.

METHODS

From January 2002 to December 2002, open reduction and internal fixation were done with two different absorbable intramedullary nails in 60 cases of metacarpal and phalanx fractures (52 cases of open fractures and 8 cases of closed fractures). The fracture locations were metacarpal in 24 cases, proximal phalanx in 22 cases and media phalanx in 14 cases. The emergency operation was performed in 47 cases, selective operation in 13 cases. Out of 60 patients, 24 were treated with intramedullary nails of poly-DL-lactic acid (PDLLA) (PDLLA group), 36 with intramedullary wire of PDLLA composed of chitosan(PDLLA+chitosan group).

RESULTS

In the PDLLA group(n = 24), the rejection occurred in 8 cases 3-4 weeks after operation. PDLLA nails were taken out in 6 of the 8 cases after 5-10 days of operation and bone healing was achieved 2 months after re-fixation by Kirschner wire; the rejection subsided in the other 2 cases after 25 days of conservative treatment, and bone fracture healed after 14 weeks. No rejection was observed with primary healing in the other 16 cases of the PDLLA group. In PDLLA + chitosan group(n = 36), the rejection occurred in 1 case 19 days after operation, but the rejection subsided after 3 days of conservative treatment. No rejection was observed in the other 35 cases with primary healing. All patients were followed up 4-11 months with an average of 6 months. No rejection was observed and bone healing was achieved during the follow-up. The time of bone healing was 6-16 weeks (8 weeks on average). There was statistically significant difference in the curative result between two groups(P < 0. 05). Conclusion Intramedullary nail of PDLLA was very suitable to fix fractures of metacarpal and phalanx. During the degradation of PDLLA, the acidic products can cause rejection. When PDLLA mixed with chitosan, PDLLA can not only strengthen the intensity but also neutralize the acidity. So the rejection can be decreased. PDLLA intramedullary nails composed of chitosan were better than PDLLA intramedullary nails in clinical treatment of metacarpal and phalanx fractures.

目的

研究两种不同可吸收髓内钉治疗掌骨和指骨骨折的效果。

方法

2002年1月至2002年12月，应用两种不同可吸收髓内钉对60例掌骨和指骨骨折（开放性骨折52例，闭合性骨折8例）行切开复位内固定术。骨折部位：掌骨24例，近节指骨22例，中节指骨14例。急诊手术47例，择期手术13例。60例患者中，24例采用聚-DL-乳酸（PDLLA）髓内钉治疗（PDLLA组），36例采用PDLLA与壳聚糖组成的髓内钉治疗（PDLLA+壳聚糖组）。

结果

PDLLA组（n=24），8例术后3～4周出现排斥反应。其中6例于术后5～10天取出PDLLA钉，改用克氏针重新固定，2个月后骨折愈合；另2例经保守治疗25天后排斥反应消退，14周后骨折愈合。PDLLA组其余16例无排斥反应，一期愈合。PDLLA+壳聚糖组（n=36），1例术后19天出现排斥反应，经保守治疗3天后排斥反应消退。其余35例无排斥反应，一期愈合。所有患者随访4～11个月，平均6个月。随访期间均未出现排斥反应，骨折均愈合。骨折愈合时间为6～16周（平均8周）。两组疗效比较差异有统计学意义（P<0.05）。结论PDLLA髓内钉适合于掌骨和指骨骨折的固定。在PDLLA降解过程中，酸性产物可引起排斥反应。PDLLA与壳聚糖混合后，不仅可增强强度，还可中和酸性，减少排斥反应。壳聚糖组成的PDLLA髓内钉在掌骨和指骨骨折的临床治疗中优于单纯PDLLA髓内钉。