交锁髓内钉与经皮锁定加压钢板内固定治疗胫骨远端骨折的疗效比较

Comparison efficacy of interlocking intramedullary nail and invasive percutaneous locking compression plate osteosynthesis for treatment of distal tibia fractures

目的：比较交锁髓内钉（ IMN）与经皮锁定加压钢板（ LCP）内固定治疗胫骨远端骨折的临床疗效。方法手术治疗87例胫骨远端骨折患者,其中42例行经皮LCP固定,45例行IMN固定。比较两组手术时间、术中出血量、并发症、骨折愈合时间及末次随访足踝功能AOFAS评分。结果患者均获得随访,时间12-45个月。两组手术时间、术中出血量、骨折愈合时间、末次随访AOFAS评分比较差异均无统计学意义（ P〉0．05）。膝关节疼痛、骨折畸形愈合发生率IMN组高于经皮LCP组,差异有统计学意义（ P〈0．05）。术后感染发生率经皮LCP组高于IMN组,差异有统计学意义（ P〈0．05）。结论 IMN和经皮LCP内固定治疗胫骨远端骨折均可取得满意疗效。术后膝关节疼痛、骨折畸形愈合等并发症方面经皮LCP内固定更具有优势,但应注意预防感染。

Abstact：Objective To compare the clinical efficacy between interlocking intramedullary nail （ IMN） and invasive percutaneous locking compression plate（ LCP） osteosynthesis in the treatment of distal tibia fractures. Methods A retrospective analysis about 87 cases suffered distal tibia fractures,42 cases with tibial fractures were treated with in-vasive percutaneous LCP osteosynthesis and 45 cases were treated with IMN. Five factors including surgery times, in-teroperation bleeding, healing times, the last follow-up American Orthopedic Foot and Ankle Society （ AOFAS） score and complication incidence rate were studied. Results All patients were followed up for 12-45 months. There were no statistically significant in the factors including surgery times, intraoperation bleeding, healing times and the last follow-up AOFAS score（P〉0. 05）. The knee joint pain and the incidence rates of malformation were higher in the IMN group than those in the LCP group, and the difference was statistically significant （P〈0. 05）. In terms of post-operative infection, the incidence rate was higher in the LCP group than those in the IMN group and the difference was statistically significant （P〈0. 05）. Conclusions Both IMN and invasive percutaneous LCP are effective for the treatment of distal tibia fractures. The LCP group has the advantages of lower rate of malformation and knee joint pain, but the prevention of infection should be taken seriously.