两种微创内固定方式治疗胫腓骨远端双骨折的对比研究

Comparison of two minimally invasive internal fixed methods for the treatment of distal tibio-fibula fractures

目的 对比分析经皮锁定加压钢板结合弹性髓内钉与交锁髓内钉结合弹性髓内钉治疗胫腓骨远端双骨折的疗效.方法 回顾性分析2006年3月至2009年3月50例胫腓骨远端双骨折病例.其中28例行经皮锁定加压钢板固定胫骨结合弹性髓内钉固定腓骨（P＋E组）,男性18例,女性10例,年龄（45±6）岁;6例为开放性骨折,22例为闭合性骨折;骨折类型按AO分型,A1型12例,A2型10例,A3型4例,C1型2例.22例行交锁髓内钉固定胫骨结合弹性髓内钉固定腓骨（N＋E组）,男性12例,女性10例,年龄（43±9）岁;4例为开放性骨折,18例为闭合性骨折;骨折类型按AO分型,A1型9例,A2型8例,A3型4例,C1型1例.对两组术中情况、术后第3天疼痛评分、骨折愈合时间、临床疗效结果及并发症进行对比分析.结果 两组在手术时间、术中失血量及术后第3天疼痛评分方面比较,差异均无统计学意义（P＞0.05）.术后P＋E组骨折愈合时间为（15.4±2.9）周,短于N＋E组的（21.1±3.0）周;P＋E组踝关节功能评分（44.3±1.7）分、患足力线评分（8.6±2.3）分,分别优于N＋E组的（41.8±2.5）分及（6.8±3.6）分,而步态异常发生率低于N＋E组（P均＜0.05）.两组术后踝关节疼痛评分、屈曲加伸展受限、内翻加外翻受限及总体优良率比较差异无统计学意义（P＞0.05）.P＋E组有3例出现并发症,少于N＋E组的8例,差异有统计学意义（P＜0.05）.结论 经皮锁定加压钢板结合弹性髓内钉治疗胫腓骨远端双骨折有一定的优越性;而交锁髓内钉结合弹性髓内钉在软组织条件较差或多段胫腓骨骨折中应用更有优势.

Objective To compare the outcome of two minimally invasive interal fixed methods for the treatment of distal tibio-fibula fractures. Methods The clinical data of 50 patients with distal tibio-fibula fractures from March 2006 to March 2009 was analyzed retrospectively. Twenty-eight patients were treated with minimally invasive percutaneous locking compression plate fixing tibia combining elastic stable intramedullary nailing fixing fibular （ Group P ＋ E）. There were 18 male and 10 female patients with a mean age of （45 ± 6 ） years. Twenty-two patients were treated with interlocking intramedullary nail fixing tibia combining elastic stable intramedullary nailing fixing fibular （Group N ＋ E）. There were 12 male and 10 female patients with a mean age of （43 ± 9 ） years. The indexs of perioperation, pain score at 3 d postoperative, bone union time, the clinical outcomes and complications postoperative were statistically compared. Results There were no statistical significance on operation time, blood loss perioperative and pain score at 3 d postoperative. Bone union time in Group N ＋ E was significantly longer than in Group P ＋ E [（21.1 ±3.0） weeks vs. （15.4 ±2.9） weeks]. Meanwile, the function of ankle score （44.3 ± 1.7 vs.41.8 ± 2. 5） and the line of foot score （ 8. 6 ± 2. 3 vs. 6. 8 ± 3.6 ） in Group P ＋ E were respectively significantly higher than that in Group N ＋ E. However, there were no statistical difference on ankle pain,buckling add stretch restricted, turn inward add evaginate restricted and the rate of good and fair between the two groups. There were 3 cases of complications postoperation in Group P ＋ E, significantly less than the 8 cases of Group N ＋ E. Conclusions Minimally invasive percutaneous locking compression plate fixingtibia combining elastic stable intramedullary nailing fixing fibular shows superiority in treatment of distal tibio-fibula fractures. However, interlocking intramedullary nail fixing tibia combining elastic stable intramedullary nailing fixing fibular has the advantages in worse soft tissue and multi-step tibio-fibula fractures.