交锁髓内钉和经皮钢板固定治疗胫骨远端干骺端骨折的疗效比较

Interlocking intramedullary nailing versus percutaneous plating in osteosynthesis of metaphyseal fractures of distal tibia

目的 比较交锁髓内钉和经皮钢板固定治疗胫骨远端干骺端骨折的疗效。方法 回顾性分析2004年5月～2005年8月采用交锁髓内钉或经皮钢板固定的51例胫骨远端干骺端骨折的治疗效果，根据内固定方式分成髓内钉组（n=27）和钢板组（n=24），比较两组的手术时间，出血量，透视次数，骨折愈合时间，踝关节前后向、内外翻成角，踝关节最大背伸度及并发症，并采用Olerud-Molander踝关节评分评价结果。结果 所有患者获得12—27个月（21．2个月）随访，两组患者在手术时间、透视次数、踝关节最大背伸度方面差异无统计学意义（P〉0．05）。所有骨折均获得愈合，平均愈合时间髓内钉组为20．0周，钢板组为18．6周。Olerud-Molander踝关节评分结果均为优良。髓内钉组具有较少的手术出血量，钢板组具有更好的骨折对线；髓内钉组有5例发生畸形愈合，钢板组有4例发生局部软组织并发症。结论 对于胫骨远端骨折，交锁髓内钉和经皮钢板固定都是有效的固定方式，经皮钢板能够提供更好的骨折端稳定性，而交锁髓内钉有利于处理伴有局部软组织损伤的骨折。

Objective To compare the clinic effects of interlocking intramedullary nailing and percutaneous plating in osteosynthesis of the metaphyseal fractures of distal tibia. Methods Between May 2004 and August 2005, 51 cases of metaphyseal fracture of distal tibia were treated in our department. With interlocking intramedullary nails were applied in 27 cases, and percutaneous plates in 24 cases. All the patients were followed up for averagely 21.2 month （from 12 to 27 months）. Their functional and radiographic outcomes were collected to compare the differences in operation time, intra-operative blood loss, X-ray exposure, bone union time, post-operative complications, posterior or anterior angulation of ankle joint, varus or valgus angulation of ankle joint, and the maximum ankle dorsiflexion degrees. Olerud-Molander functional ankle score system was used to evaluate the results. Results There was no significant difference in operation time, X-ray exposure and the maximum ankle dorsiflexion degrees between the two groups. Patients in both groups got bony union. The mean union time was 20. 0 weeks for the nailing group and 18.6 weeks for the plating group. Most patients got satisfactory functional recovery of ankle joint by Olerud-Molander system. The interlocking intramedullary nailing group suffered less intra-operational blood loss, while the percutaneous plating group had better bone fracture alignment. Five cases in the nailing group got malunion, and 4 cases in the plating group had local soft tissue infections. Conclusions Both interlocking intramedullary nailing and pereutaneous plating are proper osteosynthesis for the metaphyseal fractures of distal tibia. Comparatively, pereutaneous plate osteosynthesis can provide better fragmental stability, but it is safer to treat fractures combined with local soft tissue injury with interlocking nailing.