逆行髓内钉与钢板固定胫骨远端关节外骨折比较  

Comparison of retrograd intramedullary nail versus plate fixation for distal tibial extraarticular fractures

作　　者：廖明新 林伟明 叶剑 吴冯春 LIAO Ming-xin;LIN Wei-ming;YE Jian;WU Feng-chun(Nanping First Hospital,Fujian Medical University,Nanping,Fujian 353000,China)

机构地区：[1]福建医科大学附属南平第一医院,福建南平353000

出　　处：《中国矫形外科杂志》2025年第4期293-298,共6页Orthopedic Journal of China

基　　金：福建省自然科学基金项目(编号:2021J011430)。

摘　　要：[目的]比较胫骨逆行髓内钉(retrograde tibial intramedullary nailing,RTIN)与微创经皮钢板接骨(minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗胫骨远端关节外骨折的临床疗效。[方法]回顾性分析2021年6月—2022年12月本院收治的40例胫骨远端关节外骨折患者的临床资料。按照术前医患沟通结果,将患者分为两组,RTIN组18例,MIPPO组22例。比较两组围手术期、随访与影像资料。[结果]所有患者均顺利完成手术。RTIN组的切口总长度[(6.7±0.5)cm vs(10.4±1.1)cm,P<0.001]和住院时间[(13.9±1.9)d vs(15.6±2.0)d,P=0.012]显著少于MIPPO组;而RTIN组术中透视次数显著多于MIPPO组[(14.0±2.7)次vs(11.6±2.6)次,P=0.006]。所有患者均获12~20个月随访。RTIN组完全负重活动时间[(85.9±11.3)d vs(98.6±23.5)d,P=0.042]显著早于MIPPO组,随时间推移,两组VAS评分、AOFAS评分、踝ROM均显著改善(P<0.05),相应时间点,两组间上述指标的差异均无统计学意义(P>0.05)。RTIN组软组织激惹显著优于MIPPO组[否/是,(18/0)vs(15/7),P=0.008]。末次随访时,两组下蹲能力和Johner-Wruh评分的差异均无统计学意义(P>0.05)。影像方面,与术前相比,末次随访时两组双侧胫骨长度差、胫骨远端外侧角(lateral distal tibial angle,LDTA)、胫骨远端前侧角(anterior distal tibial angle,ADTA)均显著减小(P<0.05)。相应时间点,两组间上述影像指标的差异均无统计学意义(P>0.05)。所有病例均获得骨性愈合。[结论]两种经皮内固定技术均可有效治疗胫骨远端骨折,逆行髓内钉的临床疗效更佳。[Objective]To compare the clinical efficacy of retrograde tibial intramedullary nail(RTIN)versus minimally invasive percutaneous plate osteosynthesis(MIPPO)in the treatment of extraarticular fractures of the distal tibia.[Methods]A retrospective research was done on 40 patients who received surgical treatment for distal tibial extraarticular fractures in our hospital from June 2021 to December 2022.According to the preoperative doctor-patient communication,18 patients received RTIN,while the remaining 22 patients were treated with MIPPO.The perioperative,follow-up and imaging data of the two groups were compared.[Results]All patients were operated on successfully.The RTIN cohort was significantly less than the MIPP cohort in terms of total incision length[(6.7±0.5)cm vs(10.4±1.1)cm,P<0.001]and hospital stay[(13.9±1.9)days vs(15.6±2.0)days,P=0.012],whereas the former consumed significantly more intraoperative fluoroscopy times than the latter[(14.0±2.7)times vs(11.6±2.6)times,P=0.006].All patients in both cohorts were followed up from 12 months to 20 months,and the RTIN group regained full weight-bearing activity significantly earlier than the MIPPO group[(85.9±11.3)days vs(98.6±23.5)days,P=0.042].The VAS and AOFAS scores,as well as ankle flexion-extension ROM in both groups were significantly improved over time(P<0.05),whereas which were not statistically significant between the two groups at any time points accordingly(P>0.05).The RTIN cohort proved significantly superior to the MIPPO in terms of soft tissue irritation[no/yes,(18/0)vs(15/7),P=0.008],while,the squat capacity and Johner-Wruh scale were not significantly different between the two groups at the last follow-up(P>0.05).With respect of imaging,the bilateral tibial length discrepancy,lateral distal tibial angle(LDTA)and anterior distal tibial angle(ADTA)were significantly improved in both groups at the latest follow-up compared with those preoperatively(P<0.05),while which were not significantly different between the two groups at time point acc

关 键 词：胫骨远端关节外骨折 逆行髓内钉 微创经皮钢板接骨 临床结果 

分 类 号：R683.42[医药卫生—骨科学]