切开复位钢板内固定术与弹性髓内钉微创内固定术在胫骨干骨折患儿临床治疗中的对比观察

Comparative Observation of Open Reduction Plate Internal Fixation and Elastic Intramedullary Nail Minimally Invasive Internal Fixation in the Clinical Treatment of Children with Tibial Shaft Fracture

目的探讨切开复位钢板内固定术(ORIF)与弹性髓内钉微创内固定术在胫骨干骨折患儿中的应用效果。方法选取2018年2月—2023年2月我院收治的60例胫骨干骨折患儿为研究对象,按随机数字表法将其分为对照组和观察组,各30例。对照组行ORIF治疗,观察组行弹性髓内钉微创内固定术治疗。比较两组手术情况、手术应激指标、疼痛评分、下肢活动能力、功能障碍情况及并发症发生情况。结果观察组术中出血量少于对照组,手术、住院及骨折愈合时间均短于对照组,切口总长度短于对照组,组间差异有统计学意义(P<0.05)。术后24 h,观察组皮质醇、前列腺素E2、去甲肾上腺素水平均低于对照组,组间差异有统计学意义(P<0.05)。观察组术后24、48、72 h疼痛评分均低于对照组,组间差异有统计学意义(P<0.05)。术后3个月观察组下肢Fugl-Meyer运动功能评分法评分高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为6.67%,低于对照组的26.67%,差异有统计学意义(P<0.05)。结论弹性髓内钉微创内固定术治疗胫骨干骨折患儿效果更佳,可减轻手术创伤,降低手术应激反应,促进术后下肢运动能力恢复,且并发症发生率低。

Objective To investigate the efficacy of open reduction plate internal fixation(ORIF)and elastic intramedullary nail minimally invasive internal fixation in children with tibial shaft fractures.Methods A total of 60 children with tibial shaft fracture admitted to our hospital from February 2018 to February 2023 were selected and divided into a control group and an observation group,with 30 cases in each group according to random number table method.The control group received ORIF treatment,and the observation group received minimally invasive internal fixation with elastic intramedullary nail.Operation conditions,operative stress index,pain score,lower limb mobility,dysfunction and complications were compared between the two groups.Results The observation group had less intraoperative bleeding than the control group,shorter surgical,hospitalization,and fracture healing times,and shorter total incision length compared of the control group,and the differences between the groups were statistically significant(P<0.05).After 24 h of surgery,the levels of cortisol,prostaglandin E2,and norepinephrine in the observation group were lower than those in the control group,and the differences between the groups were statistically significant(P<0.05).The pain scores of the observation group at 24,48,and 72 hours after surgery were lower than those of the control group,and the differences between the groups were statistically significant(P<0.05).After 3 months of surgery,the lower limb Fugl Meyer motor function score in the observation group was higher than that in the control group,the differences between the two groups were statistically significant(P<0.05).The incidence of complications in the observation group was 6.67%,which was lower than 26.62%in the control group,the difference was statistically significant(P<0.05).Conclusion The effect of minimally invasive internal fixation with elastic intramedullary nail is better in the treatment of children with tibial shaft fracture,which can reduce the surgical trauma,reduce the surgical stress reaction,accelerate the recovery of lower extremity motor ability after surgery,and have fewer complications.