解剖锁定钢板与带锁髓内钉固定骨质疏松外踝骨折的疗效比较

The outcome between anatomical locking plates and interlocking intramedullary nail in the lateral malleolus fractures with osteoporosis

[目的]比较解剖锁定钢板与带锁髓内钉固定骨质疏松外踝骨折的疗效。[方法]2011年10月-2013年12月本院采用解剖锁定钢板与带锁髓内钉治疗40例骨质疏松外踝骨折患者,分为钢板组（A组）25人,髓内钉组（B组）15人,比较两组的手术时间、骨折愈合时间、踝关节功能评分、复位情况及术后并发症（切口并发症、内固定不适、内固定松动）发生率,所有数据采用SPSS 20.0分析。[结果]两组患者均获得12-24个月（平均18个月）的随访。两组手术时间及踝关节功能评分无统计学差异（P〉0.5）,骨折愈合时间差异有统计学意义（P〈0.5）。钢板组有7例切口愈合不佳,10例内固定不适,1例内固定松动,1例骨折不愈合。髓内钉组只有1例内固定不适。[结论]腓骨带锁髓内钉切口小,骨折愈合时间短,并发症少,踝关节功能恢复良好,适用于软组织条件差、老年骨质疏松、多节段腓骨远端骨折的患者。

[Objective]To compare the clinical effects between anatomical locking plates and interlocking intramedullary nail in treating lateral malleolus fractures with osteoporosis. [Method]This retrospective study was conducted on a total of 40 cases of lateral malleolus fractures with osteoporosis who were treated in our department from October 2011 to December 2013.The anatomical locking plates（ Group A） were applied in 25 cases,and interlocking intramedullary nails（ Group B） in 15 cases.Operative time,fracture union time,ankle function outcome,incidence of postoperative complications including wound complications,discomfort fixation,internal fixation loose were analyzed and compared by the SPSS 20. 0. [Result]All the patients were followed up for average 18 month（ range,12 to 24 months）. The difference in operative time and ankle function score was not statistically significant（ P〉0. 5）,while the difference in fracture union time was statistically significant（ P〈 0. 5）. Only one patient complained the symptoms relating to the metalwork in the intramedullary nail group. But several postoperative complications occured in locking plates group. Seven patients were found with poor wound healing,10 patients felt discomfort. One case was reported the fixation loosen. Nonunion was found in 1 case. [Conclusion]Fibula intramedullary nail gives good functional outcomes with minimal complications. The procedure can be performed through a small incision,protecting the soft tissue blood to accelerate the fracture healing especially for the poor condition of the soft tissue,elderly patients with osteoporosis,multiple segments of the distal fibula fracture.