髓内钉结合阻挡钉与经皮锁定钢板固定胫骨远侧干骺端骨折的比较

Comparison of Intramedullary Nails Plus Blocking Screws and Percutaneous Locking Compression Plates for Distal Tibial Metaphyseal Fractures

目的比较髓内钉结合阻挡螺钉与锁定钢板治疗胫骨远侧干骺端骨折的疗效。方法将52例胫骨远侧干骺端骨折患者按随机数字表法分为2组,分别采用经皮锁定钢板(钢板组,n=26)和髓内钉结合阻挡螺钉技术(髓内钉组,n=26)行骨折内固定治疗。对2组手术时间、透视次数、术中出血量、术后感染率、踝关节前后及内外翻成角、完全负重时间、骨折愈合率、内植物松动断裂率、踝关节活动度及Olerud-Molander踝关节评分进行比较。结果 2组均获15～21(19.0±3.4)个月随访,均显示良好踝关节功能,且手术时间、透视次数、术后感染率、踝关节前后及内外翻成角、完全负重时间、骨折愈合率、内植物松动断裂率、踝关节活动度及Olerud-Molander踝关节评分等差异无统计学意义(P>0.05)。髓内钉组较钢板组出血量多(P<0.05),钢板组有2例发生软组织并发症。结论在胫骨远端骨折治疗中,交锁髓内钉结合阻挡螺钉和经皮锁定钢板都是有效的固定方式,但对于伴有局部软组织条件损伤的患者,前者是更好的选择。

Objective To compare the clinic effects of intramedullary nails plus blocking screws and percutaneous locking compression plates on distal tibial metaphyseal fractures.Methods Fifty-two patients with distal tibial metaphyseal fractures were randomly assigned to receive internal fixation with either intramedullary nails plus blocking screws（intramedullary nail group,n=26） or percutaneous loc-king compression plates（plate group,n=26）.The operation time,X-ray exposure frequency,intraopera-tive blood loss,postoperative infection rate,posterior or anterior angulation of ankle joint,varus or valgus angulation of ankle joint,full load time,fracture healing rate,implant failure rate,range of motion of the ankle joint,and Olerud Molander ankle score were compared between the two groups.Results All the patients were followed up for an average of 19 months（range 15 to 21 months）.There were no significant differences in operation time,X-ray exposure frequency,postoperative infection rate,posterior or anterior angulation of ankle joint,varus or valgus angulation of ankle joint,full load time,fracture healing rate,implant loosening or breakage rate,range of ankle motion,and Olerud-Molander ankle score between the two group（P0.05）.However,intramedullary nail group suffered more intraop-erative blood loss than plate group（P0.05）.In addition,2 patients in plate group had local soft tissue infection.Conclusion Both intramedullary nails plus blocking screws and percutaneous locked compression plates are proper osteosynthesis for distal tibial metaphyseal fractures.But intramedullary nails plus blocking screws are superior to percutaneous locked compression plates for fractures combined with local soft tissue injury.