胫骨逆行髓内钉与微创锁定接骨板治疗胫骨远端骨折的对比研究  

Comparative study on the efficacy of retrograde tibial intramedullary nail and minimally invasive locking plate in the treatment of distal tibial fractures

作　　者：熊远飞 刘晖[1] 许遵营 张剑平 郑振华 高建霆 吴进[1] XIONG Yuanfei;LIU Hui;XU Zunying;ZHANG Jianping;ZHENG Zhenhua;GAO Jianting;WU Jin(Department of Orthopaedics,the 909th Hospital(Dongnan Hospital of Xiamen University),Zhangzhou,Fujian,363000)

机构地区：[1]第九〇九医院(厦门大学附属东南医院)骨科,福建漳州363000

出　　处：《中华骨与关节外科杂志》2025年第3期243-248,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：目的:比较胫骨逆行髓内钉与微创锁定接骨板治疗胫骨远端骨折患者的临床疗效。方法:回顾性分析2019年12月至2024年1月第九〇九医院(厦门大学附属东南医院)收治的87例胫骨远端骨折患者的临床资料。40例患者接受胫骨逆行髓内钉内固定,作为逆行髓内钉组;47例患者接受微创锁定接骨板内固定,作为微创接骨板组。记录并比较两组患者的手术时间、透视次数、住院时间、骨折愈合时间、完全负重时间、末次随访时美国足踝外科协会(AOFAS)评分、并发症等指标。结果:两组患者的性别比例、年龄、损伤原因、骨折分型等一般资料差异均无统计学意义(P均>0.05)。所有患者均获得12~24个月随访。两组患者的手术时间、骨折愈合时间、胫骨远端关节面冠状面成角、末次随访时AOFAS评分差异均无统计学意义(P均>0.05)。逆行髓内钉组患者平均透视次数为(9.6±2.6)次,多于微创接骨板组的(6.3±2.5)次;逆行髓内钉组患者平均住院时间和完全负重时间分别为(7.2±1.4)d和(10.0±1.5)周,明显短于微创接骨板组的(10.0±2.1)d和(11.8±1.8)周(P均<0.001)。微创接骨板组发生术后并发症9例(3例术区浅表感染,2例术区深部感染,2例骨折延迟愈合,1例骨不连,1例接骨板断裂),逆行髓内钉组发生术后并发症4例(2例术区浅表感染,2例内踝区疼痛),两组患者并发症发生率差异有统计学意义(P<0.001)。结论:胫骨逆行髓内钉和微创锁定接骨板均是治疗胫骨远端骨折的有效方法,其中胫骨逆行髓内钉具有术后恢复快、并发症少的优势。Objective:To compare the clinical efficacy of retrograde tibial intramedullary nail and minimally invasive locking plate in patients with distal tibial fractures.Method:A retrospective analysis was conducted on the clinical data of 87 patients with distal tibial fractures treated at the 909th Hospital(Dongnan Hospital of Xiamen University)from December 2019 to January 2024.Patients were divided into two groups:40 patients treated with retrograde tibial intramedullary nail fixation(retrograde intramedullary nail group)and 47 patients treated with minimally invasive locking plate osteosynthesis(minimally invasive plate group).The operation duration,number of intraoperative fluoroscopies,hospital stay,fractures healing time,full weight-bearing time,American Orthopaedic Foot and Ankle Society(AOFAS)score at the final follow-up,and complications were recorded and compared between the two groups.Results:There were no statistically significant differences in baseline characteristics such as gender ratio,age,causes of injury,and fracture classification between the two groups(all P>0.05).All patients were followed up for 12 to 24 months.There were no statistically significant differences between the two groups in operation duration,coronal plane angulation of the distal tibial articular surface,and AOFAS score at the final follow-up(all P>0.05).The retrograde intramedullary nail group had a higher mean number of intraoperative fluoroscopies[(9.6±2.6)times]compared to the minimally invasive plate group[(6.3±2.5)times].The average hospital stay and full weight-bearing time were significantly shorter in the retrograde intramedullary nail group[(7.2±1.4)days and(10.0±1.5)weeks,respectively]than the minimally invasive plate group[(10.0±2.1)days and(11.8±1.8)weeks,respectively](all P<0.001).Postoperative complications occurred in 9 patients in the minimally invasive plate group including 3 cases of superficial infection at the surgical site,2 cases of deep infection at the surgical site,2 cases of delayed fracture healing

关 键 词：胫骨远端骨折 逆行髓内钉 锁定接骨板 完全负重 

分 类 号：R683.4[医药卫生—骨科学]