多功能带锁髓内钉和钢板置入内固定修复关节外胫骨创伤性骨折  

Extraarticular proximal tibial fractures repaired with multifunctional locking intramedullary nail and locking plate

作　　者：陈德明[1] 徐晓阳[1] 王蔚[1] 张力[1] 常乐[1] 

机构地区：[1]武汉市汉口医院骨科,湖北省武汉市430312

出　　处：《中国组织工程研究》2016年第4期549-553,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:国内外多数学者认为带锁髓内钉可能更适合于粉碎性且软组织损伤严重的胫骨骨折,而钢板内固定则对于胫骨远端骨折更有优势。目的:对比关节外胫骨创伤性骨折实施胫骨多功能带锁髓内钉及锁定钢板修复的效果。方法:纳入156例关节外胫骨创伤性骨折患者,根据内固定修复方案分成髓内钉组和锁定钢板组,每组78例。比较两组患者的疗效,愈合时间等。治疗后3个月采用Johner-Wruh胫骨干骨折评分评估两组患者的修复效果;另外比较两组手术时间、失血量等术中指标以及骨折愈合时间、并发症发生情况。结果与结论:锁定钢板组平均骨折愈合时间为9.3个月,髓内钉组为9.2个月。治疗后3个月髓内钉组的修复效果显著优于锁定钢板组(P<0.05)。另外髓内钉组出血量少,出血时间少(P<0.05),手术难度较高。治疗后3个月在胫骨内翻/外翻、神经血管损伤、不愈合/感染等方面,髓内钉组的发生率显著低于锁定钢板组(P<0.05)。提示使用胫骨多功能带锁髓内钉修复关节外胫骨创伤性骨折固定可靠,效果确切,可减少出血量及并发症发生率,优于锁定钢板。BACKGROUND： Many researchers at home and abroad think that interlocking intramedullary nails may be more suitable for comminuted fractures of the tibia with severe soft tissue injury. Plate fixation is more advantageous for distal tibial fractures. OBJECTIVE： To compare the effects of multifunctional locking intramedullary nail and locking plate in treatment of extraarticular proximal tibial fractures. METHODS： 156 patients with extraarticular proximal tibial fractures were included and divided into intramedullary nail group（n=78） and the locking plate group（n=78） according to repair method. Curative effects and healing time were compared between the two groups. At 3 months after treatment, Johner-Wruh tibial fracture scores were used to assess the repair effect in both groups. In addition, operation time, blood loss, healing time and complications were compared between the two groups.RESULTS AND CONCLUSION： Mean healing time was 9.3 months in the locking plate group and 9.2 months in the intramedullary nail group. At 3 months after treatment, the repair effect was significantly better in the intramedullary nail group than in the locking plate group（P〈0.05）. Blood loss and time were less in the intramedullary nail group than in the locking plate group（P〈0.05）, and surgical difficulty was high. At 3 months after treatment, the incidence rates of tibia eversion/inversion, neurovascular injury and nonunion/infection were significantly lower in the intramedullary nail group than in the locking plate group（P〈0.05）. These findings confirmed that the multifunctional locking intramedullary nailing for extraarticular proximal tibial fractures obtained reliable efficacy, exact effect, reduced blood loss and low incidence of complications. Thus, it is better than locking plate.

关 键 词：胫骨骨折 内固定器 组织工程 骨科植入物 骨植入物 关节外胫骨骨折 创伤性骨折 带锁髓内钉 锁定钢板 内固定 

分 类 号：R318[医药卫生—生物医学工程]