闭合复位交锁髓内钉和微创经皮钢板内固定治疗胫骨中下段骨折  

Closed reduction and interlocking intramedullary nail and minimally invasive percutaneous plate osteosynthesis internal fixation in the treatment of middle and lower tibial fractures

作　　者：陈宁 朱金宏 成超 CHEN Ning;ZHU Jin-hong;CHENG Chao(Dept of Hand Surgery,the First People′s Hospital of Kunshan City,Kunshan,Jiangsu 215300,China)

机构地区：[1]昆山市第一人民医院手外科,江苏昆山215300

出　　处：《临床骨科杂志》2020年第5期738-742,共5页Journal of Clinical Orthopaedics

摘　　要：目的比较闭合复位交锁髓内钉(IMN)和微创经皮钢板内固定(MIPPO)治疗胫骨中下段骨折的疗效。方法对90例胫骨中下段骨折患者分别采用IMN(IMN组,45例)固定和MIPPO(MIPPO组,45例)治疗。比较两组切口长度、术中出血量、手术时间、骨折愈合情况;末次随访时采用Johner-Wruhs评分评价疗效;观察并发症发生情况。结果患者均获得1年随访。手术时间、术中出血量、切口长度和术后下地时间IMN组均短(少)于MIPPO组(P<0.001)。术后3、6个月骨痂生长例数及末次随访时骨折愈合例数IMN组多于MIPPO组(P<0.001)。随访期间,IMN组1例骨折延迟愈合,1例骨折未愈合;MIPPO组1例术后感染,4例骨折未愈合,2例膝关节疼痛,2例畸形愈合;并发症发生率IMN组低于MIPPO组(P<0.05)。末次随访时,Joher-Wruhs评分优良率IMN高于MIPPO组(P<0.001)。结论在胫骨中下段骨折的治疗中,IMN有利于维持骨折端的血供,力学稳定性好,可作为首选手术方式。Objective To compare the efficacy of closed reduction and interlocking intramedullary nail(IMN)and minimally invasive percutaneous plate osteosynthesis(MIPPO)in the treatment of middle and lower tibial fractures.Methods Ninety patients with middle and lower tibial fractures were treated with closed reduction and IMN(the IMN group,45 cases)or MIPPO(the MIPPO group,45 cases)internal fixation.The length of incision and intraoperative blood loss,operation time,fracture healing situation were compared between the two groups.The efficacy was evaluated by Johner-Wruhs score criterion at the last follow-up,and the complications were observed.Results All patients were followed up for 1 year.The operation time,intraoperative blood loss,length of incision and postoperative ambulation time in the IMN group were shorter(less)than those in the MIPPO group(P<0.001).In the IMN group,the number of osteophyte growth at 3,6 months postoperation and the case number of fracture healing at the last follow-up were more than those in the MIPPO group(P<0.001).During the follow-up period,there was a case of delayed healing and nonunion in the IMN group,respectively;and in the MIPPO group,there were 1 case of postoperative infection,4 cases of nonunion,and 2 cases of knee pain,2 cases of malformation.The incidence rate of complications in the IMN group was lower than the MIPPO group(P<0.05).At the last follow-up,the excellent-good rate of Joher-Wruhs score was higher than that of MIPPO group(P<0.001).Conclusions In the treatment of the middle and lower tibial fractures,IMN is beneficial to maintain the blood supply at the fracture end.It has good mechanical stability and can be used as the preferred surgical method.

关 键 词：微创经皮钢板内固定 交锁髓内钉 胫骨干骨折 

分 类 号：R683.42[医药卫生—骨科学] R687.3[医药卫生—外科学]