3种内固定方法治疗胫骨远段骨折的疗效比较  

Comparison effects of three internal fixation methods in the treatment of distal tibial fractures

作　　者：魏志勇 李铭雄 胡鹏 陈王 郑琼红 WEI Zhi-yong;LI Ming-xiong;HU Peng;CHEN Wang;ZHENG Qiong-hong(SectionⅡ,Dept of Lower Extremity,Quanzhou Orthopedic-Traumatological Hospital,Quanzhou,Fujian 362000,China)

机构地区：[1]泉州市正骨医院下肢二科,福建泉州362000

出　　处：《临床骨科杂志》2023年第4期574-579,共6页Journal of Clinical Orthopaedics

摘　　要：目的 比较3种内固定方法治疗78例胫骨远段骨折的疗效。方法 将78例胫骨远段骨折AO分型A型患者按内固定方法不同分为内侧钢板组(采用内侧锁定钢板固定治疗,27例)、外侧钢板组(采用外侧锁定钢板固定治疗,25例)和髓内钉组(采用髓内钉固定治疗,26例)。比较3组手术时间、术中出血量、下地完全负重时间、骨折愈合时间、术后并发症情况、膝关节和踝关节活动度。结果 患者均获得随访,时间12~24(16.5±2.5)个月。手术时间、术中出血量:内侧钢板组、外侧钢板组均明显短(少)于髓内钉组(P<0.05);内侧钢板组与外侧钢板组比较差异均无统计学意义(P>0.05)。下地完全负重时间、骨折愈合时间3组比较差异均无统计学意义(P>0.05)。术后并发症发生率:内侧钢板组明显高于外侧钢板组、髓内钉组(P<0.05);外侧钢板组和髓内钉组比较差异无统计学意义(P>0.05)。末次随访时,3组膝关节屈曲130°~140°、伸直0°~5°;踝关节跖屈40°~45°、背伸20°~25°。结论 3种内固定治疗胫骨远段骨折均能获得满意疗效。对于小腿内侧软组织浅薄或条件不佳情况建议采用外侧锁定钢板固定,可减少软组织损伤并发症的发生。因髓内钉固定常规不使用止血带,故围手术期应注意监测血流动力学。Objective To compare the effects of three internal fixation methods for treatment of distal tibial fractures.Methods The 78 patients with AO type A distal tibial fractures were divided into three groups:medial plate group(using medial locking plate,27 cases),lateral plate group(using lateral locking plate,25 cases)and intramedullary nail group(using intramedullary nail,26 cases).The operation time,intraoperative blood loss,full weight-bearing time,fracture healing time,postoperative complications and range of motion of knee joint and ankle joint were compared among the three groups.Results All patients were followed up for 12~24(16.5±2.5)months.The operation time and the intraoperative bleeding volume:the medial plate group and the lateral plate group were significantly shorter(less)than those in the intramedullary nail group(P<0.05);and there were no statistical differences between the medial-and lateral-plate group(P>0.05).The full weight-bearing time and fracture healing time had no statistical differences among the three groups(P>0.05).The incidence rate of postoperative complications:the medial plate group was significantly higher than the lateral plate group and intramedullary nail group(P<0.05),but there was no statistical difference between medial plate group and intramedullary nail group(P>0.05).At the last follow-up,the range of motion of knee joint was flexion with 130°~140°,extension with 0°~5°,ankle range of motion was metatarsal flexion 40°~45°,dorsal extension 20°~25°.Conclusions All the three kinds of internal fixation can achieve satisfactory results in the treatment of distal tibial fractures,but lateral locking plate fixation is recommended for superficial medial soft tissue or poor conditions,which can reduce the complications of soft tissue injuries.Because the tourniquet is not used routinely for intramedullary nail fixation,the hemodynamics should be monitored during the perioperative period.

关 键 词：胫骨远段骨折 内侧锁定钢板 外侧锁定钢板 髓内钉 

分 类 号：R683.42[医药卫生—骨科学] R687.32[医药卫生—外科学] R687.33[医药卫生—临床医学]