外固定架与髓内钉固定胫骨远端关节外骨折的比较  

Comparison of external fixator and intramedullary nail for fixation of extra-articular distal tibial fractures

作　　者：宫智浩 李朋[1] 宋凯凯 张德刚[1] 杜刚强[1] 杨淑野[1] 王志刚[1] 贾龙[1] 张锴[1] GONG Zhi-hao;LI Peng;SONG Kai-kai;ZHANG De-gang;DU Gang-qiang;YANG Shu-ye;WANG Zhi-gang;JIA Long;ZHANG Kai(Department of Traumatology,Affiliated Hospital,Binzhou Medical College,Binzhou 256600,China)

机构地区：[1]滨州医学院附属医院创伤骨科,山东滨州256600

出　　处：《中国矫形外科杂志》2021年第15期1345-1349,共5页Orthopedic Journal of China

基　　金：山东省医药卫生科技发展计划项目(编号2019WS324);山东省自然科学基金项目(联合项目)(编号:ZR2015HL026)。

摘　　要：[目的]比较外固定支架和髓内钉治疗胫骨远端关节外骨折的临床疗效。[方法]回顾性分析2009年1月—2013年1月本院手术治疗的82例胫骨远端关节外骨折患者的临床资料。依据术前医患沟通结果,40例采用外固定,42例采用髓内钉固定。比较两组患者的围手术期、随访和影像资料。[结果]两组患者均顺利完成手术,术中无严重并发症发生。外固定组术前等待时间、切口总长度、术中出血量、术中透视次数、住院时间显著少于髓内钉组(P<0.05),但两组手术时间的差异无统计学意义(P>0.05)。共78例患者获得完整随访,随访时间12~18个月,平均(15.13±3.48)个月。外固定组下地活动时间、完全负重活动时间显著早于髓内钉组(P<0.05)。与术后6个月相比,末次随访时两组的VAS评分显著下降(P<0.05),两组踝ROM显著增加(P<0.05),而Mazur评分的差异无统计学意义(P>0.05)。术后6个月,外固定组的VAS评分显著高于髓内钉组,而踝ROM和Mazur评分与髓内钉组差异无统计学意义(P>0.05);未次随访时,两组间VAS评分、踝ROM和Mazur评分的差异均无统计学意义(P>0.05)。术后影像显示,两组骨折复位质量的差异无统计学意义(P>0.05)。影像检查显示,至末次随访时,两组患者骨折均愈合,两组骨折愈合时间的差异无统计学意义(P>0.05)。[结论]应用外固定技术治疗胫骨远端关节外骨折,尤其是软组织条件较差患者,可减少术前等待时间,减少周围软组织损伤。[Objective]To compare the clinical outcomes of external fixator and intramedullary nail for fixation of extra-articular distal tibial fractures.[Methods]A retrospective study was done on 82 patients who received surgical treatment for extra-articular distal tibial fractures in our hospital from January 2009 to January 2013.According to the consequence of preoperative doctor-patient communication,40 patients had fractures fixed with external fixator(the EF group),while the remaining 42 patients were fixed with intramedullary nail(the IMN group).The perioperative,follow-up and imaging data were compared between the two groups.[Results]All the patients in both groups had surgical procedures completed successfully without severe complications during the operation.The EF group was significantly superior to the IMN group in term of preoperative waiting time,total incision length,intraoperative blood loss,intraoperative fluoroscopy,and hospital stay(P<0.05),but there was no statistically significant difference in operation time between the two groups(P>0.05).Of them,a total of 78 patients were followed up completely for 12~18 months with an average of(15.13±3.48)months.The EF group resumed walk⁃ing and full weight-bearing activity significantly earlier than the IMN group(P<0.05).At the last follow-up,the VAS scores decreased sig⁃nificantly(P<0.05),the ankle range of motion(ROM)increased significantly(P<0.05),while the Mazur scores showed no significant differ⁃ence(P>0.05)in both groups compared with those at 6 months after the operation.The EF group was significantly inferior to the IMN group in VAS score(P<0.05),however,no significant difference was found on ROM and Mazur scores between two groups at 6 months post⁃operatively(P>0.05).At the last follow-up,the differences in VAS,ROM and Mazur scores were not statistically significant between the two groups(P>0.05).With respect of radiographic evaluation,there was no a significant difference between the two groups in the quality of fracture reduction revealed by

关 键 词：胫骨远端骨折 外固定 髓内钉 并发症 

分 类 号：R683.42[医药卫生—骨科学]