胫骨干骨折患者交锁髓内钉术后动力化与未动力化的比较研究

A comparative study of patients with tibial shaft fracture underwent interlocking intramedullary nail postoperative between dynamization and non-dynamization

目的对比分析在骨折间隙小于2.0mm的情况下,交锁髓内钉进行动力化与未进行动力化治疗胫骨干骨折的临床疗效。方法选取该院于2009年1月至2012年12月收治的157例采用带动力孔的交锁髓内钉闭合复位固定治疗胫骨干骨折且主要骨折间隙小于2.0mm的患者,将其中同意动力化的87例患者分入动力化组并进行髓内钉的动力化,其余70例患者未进行动力化,随访并比较两组的治疗效果。结果动力化组与未动力化组愈合时间的比较差异无统计学意义[(177.4±10.3)d vs.(179.7±9.6)d,t=1.444,P>0.05];内固定术后16周,动力化组的VAS评分明显高于未动力化组[(4.1±0.6)vs.(2.3±0.8),t=16.100,P<0.05)];动力化组术后膝关节疼痛率要明显高于未动力化组(28.7%vs.12.9%,χ2=5.764,P<0.05)。结论采用闭合复位交锁髓内钉内固定治疗胫骨干骨折,当主要骨折间隙小于2.0mm时,髓内钉动力化并不比未动力化更有优势。

Objective To prospectively compare the clinical outcome of dynamization and non-dynamization of interlocking intr-amedullary nail on union of tibial shaft fractures （fracture gap〈2 .0 mm） .Methods From January 2009 to December 2012 ,157 pa-tients with tibial shaft fractures （fracture gap〈2 .0 mm） were treated in this department with internal fixation underwent static in-terlocking intramedullary nails .87 cases who accepted early dynamization were divided into the dynamization group while 70 cases who didn′t accept dynamization were divided into the non-dynamic group .Patients were followed up and the clinical outcome of two groups were compared .Results The difference of mean healing time between the two groups was not statistically significant [（177 .4 ± 10 .3）d vs .（179 .7 ± 9 .6）d ,t=1 .444 ,P〉0 .05];16 weeks after internal fixation surgery ,VAS score of the dynamization group was statistically higher than that of the non-dynamization group [（4 .1 ± 0 .6） vs .（2 .3 ± 0 .8） ,t=16 .100 ,P〈0 .05];the knee pain rate of the dynamization group was statistically higher than that of the non-dynamization group （28 .7% vs .12 .9% ,χ2 =5 .764 ,P〈0 .05） .Conclusion When treating tibial shaft fractures with closed reduction and intramedullary nail fixation ,the main fracture gap〈2 .0 mm ,early dynamization didn′t have any advantage .