胫骨中下段骨皮质形态特点与内固定选择的研究

Morphological Characteristics of Cortical Bone and Internal Fixation Choice in Mid-distal Tibia Fracture

目的从骨皮质形态研究方面来比较带锁髓内钉与解剖型钢板治疗闭合性或轻度开放性胫骨中下段骨折的疗效。方法手术治疗61例胫骨中下段骨折,其中胫骨解剖型钢板内固定34例,带锁髓内钉固定27例,骨折为闭合性或GustiloⅠ、Ⅱ度开放性骨折,比较两种技术的手术时间、住院时间等疗效指标和各项并发症发生情况。结果与解剖型钢板内固定相比,带锁髓内钉内固定操作的手术时间长(P<0.05),而住院时间两者之间没有统计学差异(P>0.05);钢板组和髓内钉组手术后骨折延迟愈合或不愈合分别为1例,6例;带锁髓内钉组发生1例腓总神经瘫;所有病例无骨折畸形愈合和脂肪栓塞综合征发生。结论对于闭合性或轻度开放性胫骨中下段骨折,解剖型钢板内固定具有更加符合生物力学、并发症少等特点,应优先考虑使用。

Objective To compare the therapeutic efficiency between the locking intramedullary nail and the anatomical form plate in treatment of the mid - distal tibia fractures. Methods Sixty - one patients with mid - distal tibial fractures （close or Gustilo type Ⅰ ＆ Ⅱ open fractures） were hospitalized between January 2000 and June 2006, and divided into the two group, the plate group （34 patients fixed with anatomical form plate） and the intramedullary nail group （27 patients fixed with locking intramedullary nail）. The therapeutic index （including the time of operation and hospitalization） and the occurrence of postoperative complications were recorded and compared separately between the two groups. Results By comparison with the plate group, the locking intramedullary nail group had a longer operating time （P 〈0.05）. However, there was no statistical difference in the time of hospitalization between the two groups. Delayed union or nonunion occurred on 1 leg in plate group and 6 legs in intramedullary nail group. Paralysis of common peroneal nerve was noted in 1 patients of intramedullary nail group. No malunion or fat embolism syndrome happened in all patients. Conclusion The anatomical form plate fixation is a top priority for patients with mid-distal tibial fractures because of biomeehanics and less complications.