钢板螺钉坚强固定与桥接固定治疗胫骨下段简单骨折的疗效比较  

Efficacy comparison of absolute and bridging fixation in plate osteosynthesis for simple distal tibia fracture

作　　者：樊军 彭静 隆晓涛 罗意 厉洋 任欢欢 Fan Jun;Peng Jing;Long Xiaotao;Luo Yi;Li Yang;Ren Huanhuan(Department of Orthopedics,Chongqing General Hospital,Chongqing 400013,China;Department of Radiology,Chongqing General Hospital,Chongqing 400013,China)

机构地区：[1]重庆市人民医院创伤骨科,400013 [2]重庆市人民医院影像科,400013

出　　处：《中华创伤杂志》2019年第1期62-70,共9页Chinese Journal of Trauma

基　　金：重庆市卫生计生委资助项目(2016MSXM064).

摘　　要：目的探讨钢板螺钉坚强固定与桥接固定治疗胫骨下段简单骨折的疗效。方法采用回顾性病例对照研究分析2013年1月-2016年11月重庆市人民医院收治的41例胫骨下段简单骨折患者临床资料,其中男24例,女17例;年龄24~70岁[(46.3±13.1)岁]。骨折AO/OTA分型:42A1型29例,42A2型9例,42A3型2例,43A1型1例。均采用钢板螺钉治疗。14例采用锁定加压钢板(LCP)坚强固定(LCP坚强固定组),12例采用LCP桥接固定(LCP桥接固定组),15例采用LCP+双向螺纹动态锁定螺钉(DDTL)桥接固定(LCP+DDTL桥接固定组)。术后1,2,3,6个月及术后1年门诊随访,复查胫腓骨正、侧位X线片。比较各组手术时间、影像学愈合时间、完全负重时间、并发症发生率及骨痂指数。结果患者均获随访12~18个月[(14.5±2.0)个月]。LCP坚强固定组、LCP桥接固定组、LCP+DDTL桥接固定组手术时间分别为(74.3±15.6)min、(78.6±20.1)min、(82.5±24.6)min(P>0.05),影像学愈合时间分别为(4.3±1.5)个月、(4.5±1.3)个月、(4.6±1.4)个月(P>0.05),完全负重时间分别为(3.4±0.7)个月、(3.5±0.6)个月、(3.6±1.1)个月(P>0.05)。组间并发症发生率差异无统计学意义(P>0.05)。LCP+DDTL桥接固定组骨痂指数为1.19±0.13,明显高于LCP坚强固定组(1.08±0.06)和LCP桥接固定组(1.09±0.09)(P<0.05)。结论对于胫骨下段简单骨折,钢板螺钉坚强固定或桥接固定均能达到良好的愈合,而动态锁定螺钉结合锁定钢板固定能促进骨痂形成,更有利于骨折愈合。Objective To compare the clinical efficacy between absolute fixation and bridging fixation in plate osteosynthesis for simple distal tibia fracture. Methods A retrospective case control study was conducted to analyze 41 patients with simple distal tibia fracture admitted to the Chongqing People's Hospital from January 2013 to November 2016. There were 24 males and 17 females, aged 24-70 years [(46.3±13.1)years]. According to AO/OTA classification, fractures weres was AO/OTA type 42A1 in 29 cases, type 42A2 in nine cases, type 42A3 in two cases, and type 43A1 in one case. All patients were treated with plate and screw fixation. According to the method of plate fixation, the patients were divided into the locking compression plate (LCP) absolute fixation group (14 patients), the LCP bridge fixation group (12 patients) and the LCP+ dynamic double thread locking screw (DDTL) bridge fixation group (15 patients). The patients were followed up by taking anteroposterior and lateral radiographs of tibia and fibula during outpatient visits 1, 2, 3, 6 months and 1 year after operation. The operation time, time to radiological fracture union, time to full weight bearing, callus index and complications were analyzed. Results All the patients were followed up for 12-18 months[(14.5±2.0)months]. In the LCP absolute fixation, LCP and LCP+ DDTL groups, the operation time was (74.3±15.6)minutes, (78.6±20.1)minutes and (82.5±24.6)minutes, respectively;the time to radiological fracture union was (4.3±1.5)months, (4.5±1.3)months and (4.6±1.4)months, respectively;the time to full weight bearing were (3.4±0.7)months, (3.5±0.6)months and (3.6±1.1)months, respectively (all P>0.05). There was no significant difference in complication incidence among the three groups (P>0.05). However, the callus index in the LCP+ DDTL group (1.19±0.13) was significantly higher than that of the LCP absolute fixation group (1.08±0.06) and that of the LCP group (1.09±0.09)(P<0.05). Conclusion For simple distal tibia fracture, both absolute and

关 键 词：胫骨骨折 骨折固定术 内 钢板 

分 类 号：R687.3[医药卫生—骨科学]