带锁髓内钉固定和钢板螺钉固定治疗胫骨干骨折的对比研究

A comparison between locked intramedullary nailing and plate-screw fixation in the treatment of tibial diaphysis fractures

目的：比较带锁髓内钉和钢板内固定两种方法治疗胫骨干骨折的效果。方法：研究对象为本院2003年1月至2008年1月收治的87例病人,其中男52例,女35例,年龄18~68岁,平均40岁。87例病人共93处胫骨干骨折,骨折部位左侧43处,右侧50处,6例病人双侧均被累及。用髓内钉固定41处骨折,用钢板螺钉固定52处骨折。比较两种内固定方式患者手术时间、膝关节活动度、踝关节活动度、愈合时间、术后并发症的差异。结果：术后随访10~30个月,平均15个月。平均手术时间髓内钉组4 d,钢板组4.6 d。两组患者手术时间、膝关节活动度和踝关节活动度之间无明显差异（P〈0.05）。愈合时间髓内钉组平均为4个月,钢板螺钉组平均为4.2个月,两组无明显差异（P〉0.05）。术后平片显示髓内钉组有2例出现旋转畸形,钢板组有3例出现成角畸形,均为胫骨远端三分之一骨折,两组并发症发生率无明显差异（P〉0.05）。结论：带锁髓内钉和钢板内固定治疗胫骨干骨折疗效相当,都可以取得理想的效果。

Objective： To compare the therapeutic effectiveness of plate-screw and locked intramedullary nailing on treatment of tibial diaphysis fractures.Methods： The study included 87 patients from 2003.1 to 2008.1,in them 52 males,35 females,mean age 40（18~68） years.87 patients with 93 tibial diaphysis fractures,6 patients had bilateral involvement.41 cases were treated by intramedullary nailing and 52 cases by plate-screw fixation.Operation time,knee joint and ankle joint range of motion,time to union,and complications after a mean follow-up of 15（range 10 to 30） months were compared between the two groups.Results： The mean operation time and the mean range of motion of the ankle and knee were found similar in both groups（P0.05）.The mean time to union was 4 months in intramedullary nailing,and 4.2 months in plate-screw fixation,there was no significant difference between them（P0.05）.Plain radiographs showed rotation in two patients following intramedullary nailing and angulation in three patients with plate-screw fixation,all of them had distal-third tibial fractures.Conclusion： Plate-screw internal fixation and locked intramedullary nailing can all yields satisfactory results in treatment of tibial diaphysis fractures.