交锁髓内钉内固定联合阻挡钉技术治疗胫骨远端关节外骨折疗效观察  

Treatment of distal tibial extraarticular fractures with interlocking intramedullary nail combined with blocking screw technique

作　　者：毛文文 陈昊 李立[1] 朱友森 陈刚[1] 张敏[1] MAO Wen-wen;CHEN Hao;LI Li;ZHU You-sen;CHEN Gang;ZHANG Min(Department of Orthopedics,the People’s Hospital of Jiangdu,Yangzhou,Jiangsu 225000,China;不详)

机构地区：[1]扬州市江都人民医院(扬州大学医学院附属医院)骨科,江苏225000 [2]扬州大学医学院,江苏扬州225000

出　　处：《中国骨与关节损伤杂志》2022年第8期807-811,共5页Chinese Journal of Bone and Joint Injury

基　　金：扬州市科技计划项目(YZ2021057)。

摘　　要：目的 观察交锁髓内钉内固定联合阻挡钉技术治疗胫骨远端关节外骨折临床疗效。方法 回顾性分析自2016-01—2020-12采用交锁髓内钉内固定联合阻挡钉技术治疗的24例胫骨远端关节外骨折(观察组),并且与单纯交锁髓内钉内固定治疗的29例胫骨远端关节外骨折进行比较(对照组)。比较两组手术时间、术中出血量、术后至开始完全负重时间、骨折愈合时间、并发症情况,末次随访时X线片上冠状面、矢状面成角,以及末次随访时Johner-Wruhs评分及踝与后足功能AOFAS评分。结果 53例均获得随访,随访时间平均16(12~24)个月。观察组与对照组手术时间、术中出血量、术后至开始完全负重时间、骨折愈合时间、感染发生率、骨折不愈合发生率、末次随访时AOFAS评分、矢状面成角、Johner-Wruhs评分差异无统计学意义(P>0.05)。观察组末次随访时冠状面成角小于对照组,骨折畸形愈合发生率低于对照组,差异有统计学意义(P<0.05)。结论 采用交锁髓内钉内固定治疗胫骨远端关节外骨折时,阻挡钉可作为辅助复位工具,同时减小了髓腔宽度使髓内钉主钉更加稳定,降低了骨折畸形愈合发生率。Objective To observe the clinical effect of interlocking intramedullary nail combined with blocking screw in the treatment of distal tibial extraarticular fractures. Methods A retrospective analysis was performed on 24 cases of distal tibial extraarticular fractures treated with interlocking intramedullary nail internal fixation combined with blocking screw technique from January 2016 to December 2020 (observation group), compared with 29 cases of distal tibial extraarticular fractures treated with interlocking intramedullary nail internal fixation alone (control group). The operation time, intraoperative blood loss, postoperative time to full weight-bearing, fracture healing time, complications, the angle of coronal plane and sagittal plane on the Xray film at the last follow-up, Johner Wruhs score and AOFAS score of ankle and hindfoot function at the last follow-up were compared between the two groups. Results All 53 cases were followed up for 12 to 24 months, with an average of 16 months. There was no significant difference between the observation group and the control group in operation time, intraoperative bleeding, time from postoperative to full weight-bearing, time of fracture healing, incidence of infection, incidence of fracture non-union, AOFAS score, sagittal angulation and Johner Wruhs score at the last follow-up (P>0.05). At the last follow-up, the angle of coronal plane in the observation group was smaller than that in the control group, and the incidence of malunion of fracture was lower than that in the control group (P<0.05). Conclusion When the interlocking intramedullary nail is used for the treatment of extraarticular fractures of the distal tibia, the blocking screw can be used as an auxiliary reduction tool. At the same time, it reduces the width of the medullary cavity, makes the main nail of the intramedullary nail more stable, and reduces the incidence of fracture malunion.

关 键 词：胫骨远端关节骨折 交锁髓内钉 阻挡钉 内固定 骨折畸形愈合 

分 类 号：R687.3[医药卫生—骨科学]