髓内钉微创治疗成人胫腓骨多段骨折与钢板内固定的疗效比较  

Efficacy comparison of intramedullary nail minimally invasive treatment and plate internal fixation for the treatment of adult multi-segmental fractures of tibia and fibula

作　　者：洪海峰 陈淏 刘钧天 王海兵 张文明[3] HONG Hai-feng;CHEN Hao;LIU Jun-tian;WANG Hai-bing;ZHANG Wen-ming(Department of orthopedics,Fuzhou First Hospital Affiliated to Fujian Medical University,Fuzhou,Fujian 350009,China)

机构地区：[1]福建医科大学附属福州市第一医院骨科,福建福州350009 [2]福建医科大学附属福州市第二医院骨科,福建福州350009 [3]福建医科大学附属第一医院骨科,福建福州350005

出　　处：《中国临床研究》2018年第11期1453-1456,1462,共5页Chinese Journal of Clinical Research

基　　金：福建省医学创新课题(2014-CX-23)

摘　　要：目的比较髓内钉微创治疗成人胫腓骨多段骨折与钢板内固定的方法和疗效。方法回顾性分析2013年7月至2016年11月福州市第一医院及福州市第二医院接收的91例胫腓骨多段骨折患者的临床资料,并将采用闭合复位髓内钉固定术的患者设为髓内钉组(n=47),将采用闭合复位钢板内固定术的患者设为钢板组(n=44),观察两组临床疗效,比较两组术前准备时间、手术时间、术中出血量、手术切口长度及住院时间、骨折愈合时间、Kofoed评分和并发症发生情况。结果髓内钉组优良率为89. 36%,钢板组优良率为88. 64%,两组优良率比较差异无统计学意义(P> 0. 05)。髓内钉组术前准备时间、住院时间、骨折愈合时间短于钢板组,术中出血量多于钢板组,差异有统计学意义(P <0. 05,P <0. 01)。两组手术时间、手术切口长度、Kofoed评分比较差异无统计学意义(P> 0. 05)。髓内钉组并发症发生率为4. 26%,钢板组为20. 45%,髓内钉组并发症发生率低于钢板组,差异有统计学意义(P <0. 05)。结论与钢板内固定相比,髓内钉微创治疗成人胫腓骨骨折,具有术前准备时间短,住院时间和骨折愈合时间短,并发症发生率低等优势,但术中出血量多,适用范围窄。两种方法均有较好的临床疗效,因此应根据临床经验及患者骨折具体情况综合分析选择合适手术固定方法。Objective To compare the method and efficacy of intramedullary nail minimally invasive treatment and steel plate internalfixation for the treatment of adult multi-segmental fractures of tibia and fibula. Methods Retrospective analysis for the clinical data of 91 patients with multi-segmental fractures of tibia and fibula admitted in Fuzhou First Hospital and Fuzhou Second Hospital between July 2013 and November 2016 was carried out. The patients were divided into bone nail group（n = 47,treat with closed reduction and interlocking intramedullary nail） and steel plate group（n = 44,treatment with closed reduction and plate fixation）. The clinical efficacy was observed in two groups,and preoperative preparation time,operative time,intraoperative blood loss,incision length,length of hospital stay,fracture healing time,Kofoed score and complications were compared between two groups. Results There was no significant difference in good and excellent rate between two groups（89. 36% vs 88. 64%,P〉0. 05）. The preoperative preparation time,length of hospital stay and fracture healing time in bone nail group were significantly shorter than those in steel plate group,and intraoperative blood loss in bone nail group was significantly more than that in steel plate group（P〈0. 05,P〈0. 01）.There were no significant differences in operative time,operative incision length and Kofoed score between two groups（all P〉0. 05）. The incidence of complication in bone nail group was significantly less than that in steel plate group（4. 26% vs20. 45%,P〈0. 05）. Conclusion For the treatment of adult fractures of tibia and fibula,intramedullary nail minimally invasive treatment has the advantages of shorter preoperative preparation time,length of hospital stay,fracture healing time and lower incidence of complication compared with steel plate group,however,the amount of intraoperative blood loss is more,and the scope of application is narrow. Both two methods have good clinical efficacy,therefore,the suitable surgic

关 键 词：胫腓骨多段骨折 髓内钉 微创 钢板内固定 并发症 

分 类 号：R683.42[医药卫生—骨科学]