两种内固定治疗胫骨中下段骨折的疗效比较  

Comparison efficacy of two internal fixation methods for treatment of the middle-distal tibial fractures

作　　者：何涛 侯绍平[1] 吕国荣[1] 宋晓飞 汪军[1] 龙俊任[1] HE Tao;HOU Shao-ping;L Guo-rong;SONG Xiao-fei;WANG Jun;LONG Jun-ren(Dept of Orthopaedics,the People′s Hospital of Langzhong City,the Affiliated Langzhong Hospital of North Sichuan Medical College,Langzhong,Sichuan 637400,China)

机构地区：[1]阆中市人民医院(川北医学院附属阆中医院)骨科,四川阆中637400

出　　处：《临床骨科杂志》2024年第2期270-274,共5页Journal of Clinical Orthopaedics

摘　　要：目的比较交锁髓内钉和微创经皮锁定钢板固定治疗胫骨中下段骨折的疗效。方法将100例胫骨中下段骨折患者按内固定方式不同分为交锁髓内钉组(采用交锁髓内钉固定治疗,50例)和锁定钢板组(采用微创经皮锁定钢板内固定治疗,50例)。比较两组手术情况、骨折愈合时间、术后部分负重行走时间、术后并发症发生情况、Johner-Wruhs评分、踝关节活动度、AOFAS踝-后足评分。结果患者均获得随访,时间12~15(12.26±5.63)个月。术中出血量、切口长度、住院时间:交锁髓内钉组均少(短)于锁定钢板组(P<0.01)。骨折愈合时间:交锁髓内钉组短于锁定钢板组(P<0.01)。术后部分负重行走时间:交锁髓内钉组早于锁定钢板组(P<0.01)。术后并发症发生率:交锁髓内钉组低于锁定钢板组(P<0.05)。术后12个月Johner-Wruhs评分优良率、末次随访时踝关节活动度及术后3、12个月AOFAS踝-后足评分:交锁髓内钉组均优于锁定钢板组(P<0.05)。结论与微创经皮锁定钢板内固定相比,交锁髓内钉固定治疗胫骨中下段骨折更符合力学原理,更利于骨折愈合,患者术后下地行走时间更早,并发症发生率更低,踝关节功能恢复更佳。Objective To compare the efficacy of locking intramedullary nail and minimally invasive percutaneous plate osteosynthesis in treating middle-distal tibial fractures.Methods The 100 patients with middle-distal tibial fractures were divided into two groups according to different internal fixation methods:the interlocking intramedullary nail group(50 cases were treated with interlocking intramedullary nail fixation)and the locking plate group(50 cases were treated with minimally invasive percutaneous locking plate internal fixation).The surgical conditions,fracture healing time,postoperative partial weight-bearing walking time,postoperative complications,Johner-Wruhs score,ankle joint activity and AOFAS ankle-hindfoot score were compared between the two groups.Results All patients were followed up for 12~15(12.26±5.63)months.The intraoperative bleeding volume,incision length,the hosptialization time in the interlocking intramedullary nail group were less(shorter)than those of the locking plate group(P<0.01).The fractures healing time of interlocking intramedullary nail group group was shorter than locking plate group(P<0.01).The partial weight-bearing walking time of interlocking intramedullary nail group group was earlier than that of the locking plate group(P<0.01).The postoperative complications incidence rate in the interlocking intramedullary nail group was lower than the locking plate group(P<0.05).The excellent-good rate of Johner-Wruhs scores at the postoperative 12 months,ankle joint activity at the last follow-up and AOFAS ankle-hindfoot scores at the postoperative 3,12 months:the interlocking intramedullary nail group were all better than the locking plate group(P<0.05).Conclusions Compared with minimally invasive percutaneous plate osteosynthesis,the interlocking intramedullary nail in treating middle-distal tibial factures is more consistent with the mechanical principle,and it is more beneficial to fractures healing,the postoperative walking time is earlier,with fewer complication and better recovery

关 键 词：胫骨中下段骨折 内固定 交锁髓内钉 微创经皮锁定钢板 

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]