临床误诊误治

目的 探究扩髓物回植在闭合复位髓内钉固定术治疗股骨骨折患者中的价值。方法 选取2022年2月至2024年2月收治股骨骨折患者62例，随机数字表法分为观察组和对照组各31例，观察组在髓内钉固定术中进行扩髓物回植，对照组行髓内钉固定术。比较两组围术期指标、骨折愈合指标、血清骨代谢指标[骨碱性磷酸酶(BALP)、骨钙素、Ⅰ型原胶原氨基末端前肽(PⅠNP)]、骨折端骨密度[骨折端骨密度变化值(ROI 1)、骨折近端骨密度变化值(ROI 2)、骨折远端骨密度变化值(ROI 3)]、下肢功能评分及并发症。结果 两组围术期指标比较差异无统计学意义(P>0.05)；观察组骨痂形成、骨折愈合及完全负重时间较对照组缩短(P<0.05)；术后2、4周，观察组血清BALP、骨钙素、PⅠNP水平高于对照组(P<0.05)；术后第3个月，观察组失访1例，对照组失访2例；术后1、3个月观察组ROI 1、ROI 2、ROI 3以及下肢功能评分高于对照组(P<0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论 股骨骨折闭合复位髓内钉固定时采用扩髓物回植能改善骨代谢，增强骨折处骨密度，促进骨折愈合，改善下肢功能，且不会增加并发症风险。

Objective To explore the value of reimplantation of medullary expanders in the treatment of patients with femoral fractures through closed reduction and intramedullary nail fixation. Methods A total of 62 patients with femoral fractures admitted from February 2022 to February 2024 were selected and randomly divided into the observation group(n=31) and the control group(n=31) by the random number table method. Among them, the observation group underwent reimplantation of medullary expanders during intramedullary nail fixation, while the control group underwent intramedullary nail fixation. The perioperative indicators, fracture healing indicators, serum bone metabolism indicators [bone alkaline phosphatase(BALP), osteocalcin, procollagen typeⅠN-terminal propeptide(PⅠNP)], bone mineral density at the fracture end [change value of bone mineral density at the fracture end(ROI 1), change value of bone mineral density at the proximal fracture end(ROI 2), change value of bone mineral density at the distal fracture end(ROI 3)], lower extremity function score and complications were compared between the two groups. Results There was no significant difference in the perioperative indicators between the two groups(P>0.05). The callus formation, fracture healing and complete weight-bearing time in the observation group were shorter than those in the control group(P<0.05). At 2 and 4 weeks after operation, the levels of serum BALP, osteocalcin and PⅠNP in the observation group were higher than those in the control group(P<0.05). At 3 months after operation, one patient in the observation group was lost to follow-up and two patients in the control group were lost to follow-up. At 1 and 3months after operation, the ROI 1, ROI 2, ROI 3 and lower extremity function score of the observation group were higher than those of the control group(P<0.05). There was no significant difference in the incidence of complications between the two groups(P>0.05). Conclusion During closed reduction and intramedullary nail fixation of femoral fractures, the reimplantation of medullary expanders can improve bone metabolism, enhance bone mineral density at the fracture site, promote fracture healing, improve lower extremity function, and will not increase the risk of complications.