髓内钉联合空心螺钉与传统钢板内固定治疗胫骨中下段骨折的疗效对比  

Comparison of curative effect of intramedullary nail combined with cannulated screw and traditional plate internal fixation in the treatment of fracture of middle and lower tibia

作　　者：曹开学 邬红卫 李亮[1] 李佳斌 黄攀[1] 夏天[2] Cao Kaixue;Wu Hongwei;Li Liang;Li Jiabin;Huang Pan;Xia Tian(Department of Trauma and Orthopedics,Union Jiangnan Hospital,Huazhong University of Science and Technology(First People’s Hospital of Jiangxia District,Wuhan),Wuhan 430200,China;Department of Trauma and Orthopedics,Union Hospital Affiliated to Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学协和江南医院(武汉市江夏区第一人民医院)创伤骨科,武汉430200 [2]华中科技大学附属协和医院创伤骨科,武汉430022

出　　处：《创伤外科杂志》2022年第9期675-680,共6页Journal of Traumatic Surgery

摘　　要：目的探讨胫骨中下段骨折治疗中,髓内钉联合空心螺钉与传统钢板内固定治疗的疗效。方法前瞻性分析2017年1月1日—2021年1月1日在华中科技大学协和江南医院就诊的胫骨中下段骨折患者98例,其中男性58例,女性40例;年龄24~53岁,平均40.2岁;摔伤44例,扭伤35例,其他19例。根据患者住院病历号末尾奇偶数分为联合组(n=53)和传统组(n=45),联合组给予髓内钉联合空心螺钉治疗,传统组给予传统钢板内固定治疗,观察两组手术时间、术中出血量等,采用美国矫形外科足踝协会(AOFAS)踝与后足功能评分系统评价患者踝关节,采用Merchant-Dietz评价系统分析患者膝关节功能。结果联合组手术时间(125.5±26.7)min,明显长于传统组(99.8±20.1)min(P<0.05);联合组和传统组术中出血量、骨折愈合时间、并发症比较差异无统计学意义(P>0.05);联合组术后1、3个月踝关节背伸活动度和踝关节跖屈活动度(15.2±1.6)°和(33.4±2.5)°、(17.2±1.8)°和(36.1±2.7)°,明显高于传统组(12.1±1.5)°和(27.2±3.1)°、(14.2±1.3)°和(32.2±3.0)°(P<0.05);联合组术后1、3个月AOFAS评分中,异常步态、前后活动评分(2.0±0.6)分和(2.4±0.4)分、(3.4±0.7)分和(3.0±0.4)分,明显高于传统组(1.2±0.3)分和(1.2±0.3)分、(2.5±0.7)分和(2.2±0.4)分(P<0.05);联合组术后1、3个月Merchant-Dietz评分中,步态和关节活动范围评分分别为(7.6±1.0)分和(8.1±0.9)分,(8.0±0.8)分和(8.6±0.6)分,明显高于传统组(6.8±0.9)分和(7.7±0.9)分、(7.0±0.9)分和(7.9±0.9)分(P<0.05)。术后6个月两组踝关节活动度、AOFAS评分、Merchant-Dietz评分比较差异无统计学意义(P>0.05)。结论相较于传统钢板内固定治疗,髓内钉联合空心螺钉治疗胫骨中下段骨折有较好的效果。Objective To investigate the curative effect of intramedullary nail combined with cannulated screw and traditional plate internal fixation in the treatment of fracture of middle and lower tibia.Methods From January 1,2017 to January 1,2021,98 patients with fracture of middle and lower tibia were selected.There were 58 males and 40 females,aging 24-53 years,average 40.2 years.Causes of injury:fall injury in 44 cases,sprain in 35 cases,and others in 19 cases.Patients were divided into observation group(n=53)and control group(n=45)according to the odd even number at the end of the patient’s inpatient medical record number.The observation group was treated with intramedullary nail combined with cannulated screw,and the control group was treated with traditional plate internal fixation.The operation time and blood loss and so on were observed,the ankle function was evaluated by the American Orthopedic foot and ankle Association(AOFAS)ankle and hindfoot function score system,and the function of knee joint was analyzed by Merchant-Dietz evaluation system.Results The operation time of the observation group was(125.5±26.7)min,which was significantly higher than that of the control group(P<0.05);There was no significant difference in intraoperative blood loss,fracture healing time and complications between the two groups(P>0.05);One month after operation,the range of motion of ankle dorsiflexion and ankle plantar flexion in the observation group were(15.2±1.6)°and(33.4±2.5)°,(17.2±1.8)°and(36.1±2.7)°,which were significantly higher than those in the control group(P<0.05);One month after operation,the Abnormal gait,anteroposterior activity score of AOFAS scores of the observation group were(2.0±0.6)and(2.4±0.4),(3.4±0.7)and(3.0±0.4),which were significantly higher than those of the control group(P<0.05);One month after operation,the gait and range of motion of Merchant-Dietz scores of the observation group were(7.6±1.0)and(8.1±0.9),(8.0±0.8)and(8.6±0.6),which were significantly higher than those of the co

关 键 词：胫骨中下段骨折 髓内钉 空心螺钉 钢板内固定 

分 类 号：R683.42[医药卫生—骨科学]