解剖型锁定钛板与髓内钉治疗胫骨远端骨折的疗效比较  

Comparison of Anatomic Locking Titanium Plate and Intramedullary Nail in the Treatment of Distal Tibial Fractures

作　　者：马梦君 陈彦博 曾钢[2] 陈宸 宋卫东[2] 刘文宙[2] MA Mengjun;CHEN Yanbo;ZENG Gang;CHEN Chen;SONG Weidong;LIU Wenzhou(Orthopaedic Surgery,The Eighth Affiliated Hospital,Sun Yat-sen University,Shenzhen 518033,China;Orthopaedic Surgery,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510000,China)

机构地区：[1]中山大学附属第八医院骨外科,广东深圳518033 [2]中山大学孙逸仙纪念医院骨外科,广东广州510000

出　　处：《中山大学学报（医学科学版）》2024年第1期108-113,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(82102530);广东省自然科学基金(2022A1515012334)。

摘　　要：【目的】对比应用解剖型锁定钛板与髓内钉治疗胫骨远端骨折的临床疗效与并发症情况。【方法】自2019年9月至2021年9月,于中山大学孙逸仙纪念医院诊断为胫骨远端AO-A型骨折的手术患者纳入本研究,共32例。其中15例采用钛板螺钉治疗,17例采用髓内钉治疗。比较两组一般手术指标、骨折愈合时间、术后并发症发生情况、手术前后VAS评分及术后踝关节功能。【结果】患者均获得随访,随访时间10~20个月,平均12个月。髓内钉组手术时间、术中透视次数均长于钛板螺钉组,但术前等待时间、住院天数少于钛板螺钉组,统计学差异显著(P<0.05);两组骨折愈合时间相比,差异无统计学意义(P>0.05);术后6周,两组VAS评分均低于术前,统计学差异显著(P<0.05);髓内钉组与钛板螺钉组相比,手术前后VAS评分差异无统计学意义(P>0.05);术后6月AOFAS评分、术后1年踝关节活动度、并发症发生率髓内钉组优于钛板螺钉组,统计学差异显著(P<0.05);术后1年AOFAS评分两组差异无统计学意义(P>0.05)。【结论】钛板螺钉与髓内钉均是治疗胫骨远端AO-A型骨折的有效术式,远期临床疗效无明显差异。髓内钉的软组织并发症较少,对踝关节活动度影响更小,康复更快,安全性更高,而钛板螺钉发生术后软组织感染的概率较大。我们建议在临床工作中,应该做好患者的术前评估,在把握适应症的前提下,髓内钉并发症更少,有一定优势。【Objective】To compare the clinical efficacy and complications of anatomic locking titanium plate(hereinafter referred to as“titanium plate screw”)and intramedullary nail in the treatment of distal tibial fractures.【Methods】From September 2019 to September 2021,32 patients diagnosed with AO-A fracture of distal tibia at Sun Yat-sen Memorial Hospital of Sun Yat-sen University were included in this study.Of these,15 cases were treated with titanium plate screws and 17 cases were treated with intramedullary nails.General surgical indexes,fracture healing time and postoperative operation were compared between the two groups.【Results】All patients were followed up for 10 to 20 months,with an average of 12 months.The operative time and intraoperative fluoroscopy times of intramedullary nail group were longer than those of titanium plate screw group,but the preoperative waiting time and hospitalization days was less or were fewer than those of titanium plate screw group,the difference was statistically significant(P<0.05).There was no significant difference in fracture healing time between the two groups(P>0.05).At 6 weeks after operation,VAS scores in both groups were lower than those before operation,with statistically significant difference(P<0.05).There was no significant difference in VAS scores between the intramedullary nail group and the titanium plate screw group(P>0.05).AOFAS scores 6 months after surgery,ankle joint motion and complication rate 1 year after surgery in intramedullary screw group were better than those in titanium plate screw group,and the differences were statistically significant(P<0.05).There was no significant difference in AOFAS scores between the two groups at 1 year after operation(P>0.05).【Conclusions】Titanium plate screw and intramedullary nail are both effective methods for the treatment of distal tibial AO-A fracture,and there is no significant difference in long-term clinical efficacy.Intramedullary nail has fewer soft tissue complications,less impact on ankle moti

关 键 词：胫骨远端骨折 解剖型锁定钛板 髓内钉 治疗 疗效 

分 类 号：R687.3[医药卫生—骨科学]