胫骨开放性骨折分期治疗中髓内钉与锁定加压钢板固定的疗效对比

Comparison of locking compression plate and intramedullary nail in staged treatment of open tibial fractures

目的 比较胫骨开放性骨折分期治疗中髓内钉与锁定加压钢板（LCP）固定的疗效.方法 回顾性分析2008年2月至2013年1月采用外固定支架固定联合负压封闭引流术（VSD）后二期应用髓内钉或LCP固定的55例胫骨开放性骨折患者资料,男39例,女16例;年龄为17 ～ 72岁,平均32.5岁;损伤侧别：左侧24例,右侧28例,双侧3例.开放性骨折按Gustilo分型：Ⅰ型18侧,Ⅱ型24侧,ⅢA型16侧;骨折AO分型：42-A型6侧,42-B型32侧,42-C型20侧.32例（34侧）患者采用带锁髓内钉固定（髓内钉组）,23例（24侧）患者采用LCP固定（LCP组）.比较两组患者的骨折愈合时间、末次随访时患肢功能及术后并发症等.结果 55例患者术后获12 ～ 34个月（平均18个月）随访.髓内钉组和LCP组患者骨折愈合时间平均分别为（24.2±5.3）、（26.1±7.2）周,两组比较差异无统计学意义（P＞0.05）.末次随访时按照Johner-Wruhs评分系统评定患肢功能：髓内钉组优13侧,良18侧,中3侧,优良率为91.2％;LCP组优9侧,良12侧,中3侧,优良率为87.5％,差异无统计学意义（P＞0.05）.髓内钉组和LCP组患者术后并发症发生率分别为20.6％ （7/34）、12.5％ （3/24）,差异无统计学意义（P＞0.05）.结论 在胫骨开放性骨折的分期治疗中,二期手术无论是采用髓内钉还是LCP都能有效维持骨断端的稳定性,并发症少,临床疗效满意.

Objective To compare the clinical efficacy of locking compression plate （LCP） versus intramedullary nail in staged treatment of complex compound tibial fractures.Methods From February 2008 to January 2013,55 cases of complex tibial open fracture were treated at our department.They were 39 men and 16 women,with an average age of 32.5 years （from 17 to 72 years）.The fractures were on the left side in 24 patients,on the right side in 28 and both sides in 3.By Gustilo classification,18 fractures were type Ⅰ,24 type Ⅱ and 16 type ⅢA; by AO classification,6 fractures were type 42-A,32 type 42-B,and 20 type 42-C.They were treated by external fixation and vacuun sealing drainage （VSD） at the primary stage followed by fixation with LCP or intramedullary nail at the secondary stage.Locking intramedullary nail was used in 32 patients （34 fractures） and LCP in 23 patients （24 ffractures）.The 2 groups were compared in terms of fracture healing time,functional recovery of the affected limbs,and postoperative complications.Results The 55 patients were followed up for 12 to 34 months （average,18 months）.All the fractures were healed from 16 to 48 weeks after the staged treatment,with an average of 24.2±5.3 weeks in the intramedullary nail group and 26.1 ± 7.2 weeks in the LCP group.There was no significant difference in the healing time between the 2 groups （P 〉 0.05）.According to the functional assessment by the Johner-Wruhs system,the intramedullary nail group had 13 excellent cases,18 good ones and 3 fair ones （the excellent to good rate,91.2%） while the LCP group had 9 excellent,12 good and 3 fair ones （the excellent to good rate,87.5%）,showing no significant between-group difference （P 〉 0.05）.There was no significant difference either between the 2 groups regarding the postoperative complication rate [20.6% （7/34） for the intramedullary nail group versus 12.5% （3/24） for the LCP group] （P 〉 0.05）.Conclusion In the staged treatment of complex open tibia fractures,both intramedullary nail and LCP can result in reliable fixation of the fracture ends,a low complication rate and thus satisfactory clinical efficacy.