经皮闭合复位锁定钢板和交锁髓内钉及切开复位钢板置入修复胫骨中下段骨折：生物稳定性比较

Percutaneous closed reduction locking compression plate, percutaneous closed reduction interlocking intramedullary nail and open reduction plate in the treatment of tibial fracture: comparison of biostability

背景:胫骨中下段骨折由于无肌肉覆盖,软组织薄,创伤后易发生粉碎的复杂骨折,致术中复位固定较为困难。其临床效果往往和骨折类型、软组织损伤程度、治疗方法及内固定的选择密切相关。胫骨中下段骨折一般以内固定为主,尽管内固定方法很多,但微创的坚强固定一直是胫骨骨折治疗的难点和研究热点。目的:比较经皮闭合复位锁定钢板、经皮闭合复位交锁髓内钉与切开复位钢板置入内固定修复胫骨中下段骨折的临床效果。方法:入选180例胫骨中下段骨折患者,随机分为经皮闭合复位锁定钢板组、经皮闭合复位交锁髓内钉组与切开复位钢板组,分别进行内固定修复治疗。内固定后随访时间为12-24个月。从切口长度、手术时间、术中透视时间、术中出血量、内固定后并发症等方面比较3组的修复效果。结果与结论:剔除失随访患者,经皮闭合复位锁定钢板组56例,经皮闭合复位交锁髓内钉组52例,切开复位钢板组48例进入结果分析。经皮闭合复位锁定钢板组、经皮闭合复位交锁髓内钉组在切口长度、术中出血量等方面明显优于切开复位钢板组(P<0.05),而透视时间方面经皮闭合复位锁定钢板组显著长于交锁髓内钉和切开复位内固定组(P<0.05),手术时间方面3组差异无显著性意义。在并发症发生率方面,经皮闭合复位锁定钢板组为11%,经皮闭合复位交锁髓内钉组及切开复位钢板组均为27%。提示对于修复胫骨中下段骨折,闭合复位锁定钢板内固定创伤小,不破坏骨折端血供,具有良好的生物力学稳定性,可以作为胫骨中下段骨折的良好选择;闭合复位交锁髓内钉固定操作简单,也是胫骨中下段骨折的常用方法;切开复位钢板内固定对骨折端剥离较多,血供破坏大,并发症较多,应谨慎选择。

BACKGROUND：The distal tibia shaft fracture is prone to be comminuted after trauma due to the absence of muscle covering and the thin soft tissue, and intraoperative reduction and fixation are difficult. Clinical efficacy is closely related to the type of fracture, degree of soft tissue injury, choice of therapy and internal fixation. Internal fixation is the main treatment for the distal tibia shaft fracture, and a microinvasive, strong fixation is the focus of tibial fracture treatment although many methods for internal fixation are present. OBJECTIVE：To explore clinical efficacy of the treatment of distal tibia shaft fracture using percutaneous locking compression plate, interlocking intramedul ary nail and open reduction with internal fixation. METHODS：A total of 180 patients with distal tibia shaft fracture were randomized into three groups, receiving internal fixation treatment using percutaneous locking compression plate, interlocking intramedul ary nail or open reduction. Al patients were fol owed up for 12-24 months. The clinical outcomes of the treated patients in three groups were compared through the observations of incision length, operation time, intraoperative fluoroscopy time, intraoperative blood loss, complications after fixation. RESULTS AND CONCLUSION：After excluding the loss of fol ow-up, 56 cases receiving percutaneous locking compression plate, 52 cases receiving interlocking intramedul ary nail and 48 cases receiving open reduction were involved in the final analysis. The incision length and intraoperative blood loss in the groups of percutaneous locking compression plate and interlocking intramedul ary nail were significantly better than that of open reduction （P〈0.05）. Intraoperative fluoroscopy time in the group of percutaneous locking compression plate was significantly longer than that in other two groups （P〈0.05）. The operation time showed no significant differences among three groups. The rate of complications was 11%in the group of percutaneous locking compression plate, and 27%in the groups of interlocking intramedul ary nail and open reduction with internal fixation. Percutaneous locking compression plate is a good choice for the distal tibia shaft fracture due to smal injury, good biomechanical stability, and no influence on blood supply at fracture end;interlocking intramedul ary nail is also a useful technique due to simple operations. Open reduction with internal fixation should be chosen careful y due to great dissection, great influence on blood supply and high complication rate.