交锁髓内钉闭合穿钉联合阻挡螺钉固定治疗胫骨干中下段骨折疗效评价  

Clinical outcome of closed interlocking intramedullary nailing combined with fixation by blocking screw for middle and lower segment of the tibia fractures

作　　者：徐新立 杨林 XU Xinli;YANG Lin(Department of Orthopedics, General Hospital of Pingmei Shenma Medical Group, Pingdingshan 467000, Henan, China)

机构地区：[1]平煤神马医疗集团总医院骨关节科

出　　处：《中华骨与关节外科杂志》2019年第7期533-537,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:经皮微创接骨板固定术(MIPPO)治疗胫骨干中下段骨折时髓内钉容易沿交锁钉移动,有畸形愈合、复位丢失以及骨不连等风险。如何避免髓内钉沿交锁钉移动成为骨外科关注的重要课题之一。目的:与MIPPO术比较,评价交锁髓内钉闭合穿钉联合阻挡螺钉固定治疗胫骨干中下段骨折的临床疗效。方法:回顾性分析2014年4月至2016年4月间收治的胫骨干中下段骨折患者47例。所有患者均为单侧骨折。其中25例患者采用交锁髓内钉闭合穿钉联合阻挡螺钉固定治疗(观察组),22例患者采用MIPPO术治疗(对照组)。记录两组患者手术时间、术中出血量、术后恢复及骨折愈合时间,末次随访时采用Burwell-Charnley标准评估两组患者手术疗效,同时观察两组患者术后并发症发生情况,并进行比较。结果:所有患者随访2~4年,平均(2.9±0.4)年。与对照组患者比较,观察组患者手术时间较长,术中出血量较多,但术后恢复及骨折愈合时间均较短,且差异均有统计学意义(t=8.676,P<0.001;t=6.648,P<0.001;t=2.646,P=0.011;t=9.456,P<0.001);经Burwell-Charnley标准评价,观察组患者手术疗效优良率高于对照组患者,而并发症发生率低于对照组患者,且差异均有统计学意义(χ2=6.698,P=0.010;χ2=4.023,P=0.034)。结论:交锁髓内钉闭合穿钉联合阻挡螺钉固定治疗胫骨干中下段骨折虽较MIPPO术手术时间长,但骨折愈合时间更短、并发症更少。Background: Intramedullary nail is easy to move after minimally invasive percutaneous plate fixation(MIPPO) for middle and lower segment of the tibia fractures, which may result in the risk of malunion, reduction loss and bone nonunion.How to avoid the movement of intramedullary nail along the interlocking nail has become one of the important concerns in orthopedic surgery. Objective: To compare the clinical efficacy between MIPPO and closed interlocking intramedullary nailing combined with fixation by blocking screw for middle and lower segment of the tibia fractures. Methods: Forty-seven patients with unilateral middle and lower segment of the tibia fractures treated between April 2014 and April 2016 were retrospectively analyzed. Of them, 25 patients were treated with closed interlocking intramedullary nailing combined with fixation by blocking screw(observation group), and 22 patients were treated with MIPPO(control group). The operation time, intraoperative blood loss, postoperative recovery and fracture healing time were recorded. At the last follow-up, the Burwell-Charnley criterion was used to evaluate the clinical outcome. Postoperative complications were compared between two groups. Results: All the patients were followed up for 2 to 4 years with an average of(2.9±0.4) years. Compared with control group, the observation group had longer operation time, more intraoperative blood loss, shorter postoperative recovery and fracture healing time(t=8.676, P<0.001;t=6.648, P<0.001;t=2.646, P=0.011;t=9.456, P<0.001). According to the Burwell-Charnley criterion, the excellent rate of surgical treatment was significantly higher in the observation group than that in the control group, while the incidence of complications was significantly lower in the observation group than that in the control group(χ2=6.698, P=0.010;χ2=4.023, P=0.034). Conclusions: Although closed interlocking intramedullary nailing combined with blocking screw placement takes a longer operation time than MIPPO for the treatment of middle and l

关 键 词：交锁髓内钉 阻挡螺钉 经皮微创接骨板固定术 胫骨干中下段骨折 

分 类 号：R687.3[医药卫生—骨科学]