60例胫骨干骨折三种手术方法的比较分析

Comparative analysis of three mothods in treatment of tibial shaft fracture of 60 cases

目的 研究经皮微创锁定加压钢板、交锁髓内钉及交锁髓内钉加自制小型牵引外固定器三种微创手术方法对胫骨干骨折的临床疗效.方法 2012年1月-2016年8月,对60例胫骨干骨折患者的临床资料进行回顾性分析.分为A,B,C组,A组：经皮微创锁定加压钢板内固定;B组：交锁髓内钉内固定;C组：交锁髓内钉内固定,并术中应用自制小型牵引外固定器行患肢固定及牵引复位.比较三组手术时间、术中出血量、骨折愈合时间、临床疗效的情况.结果 60例患者均获随访,随访时间为3-22个月,平均12个月.C组的手术时间、术中出血量、骨折愈合时间均少于A组和B组,差异有统计学意义（P〈0.05）;A组和B组在手术时间、术中出血量、骨折愈合时间方面差异无统计学意义（P〉0.05）;A,B,C三组在临床疗效方面差异无统计学意义（P〉0.05）.结论 交锁髓内钉与经皮微创锁定加压钢板两种微创手术方法治疗胫骨干骨折的疗效相当,都可以取得理想的效果;在胫骨干骨折交锁髓内钉内固定术中,小型牵引外固定器起到固定小腿、持续牵引的作用,可减轻助手辛苦,避免在复位过程中由于经常变换位置而造成骨折周围软组织的二次损伤,明显缩短手术时间,减少术中出血量及骨折愈合时间,值得临床推广应用.

Objective To research the clinical effec of the percutaneous minimally invasive locking compression plate, locked intramedullary nailing and the self-maded miniature traction eternal fixator through lock intramedullary nail fixing on treatment of tibial fractures. Methods A retrospective analysis was performed on 60 patients with tibial fractures from January 2012 to August 2016. They were divided into three group. A group was treated with the percutaneous minimally invasive locking compression plate; B group only was treated with intramedullary nail fixing; C group was treated with intramedullary nail fixing,and we applied the self-maded miniature traction eternal fixator to fix and tow the tibial. The operative time, the blood-loss in operation, the fracture healing time and the clinical result were compared. Results All the 60 cases were followed up from 3 to 22 months, （average 12 months）. The operative time, the blood-loss in operation, the fracture healing time were less in C group, and there were significant differences in the comparation. The operative time, the blood-loss in operation, the fracture healing time were similar between A and B. The clinical result were similar between A,B and C. Conclusion The percutaneous minimally invasive locking compression plate and locked intramedullary nailing can get the same clinical effec on treatment of tibial diaphysis fractures, the self-maded miniature traction eternal fixator can fix and tow the tibial, reduce the assistant＆#39;＆#39;s hard, avoid soft tissue injury, shorten operation time, reduce the surgical bleeding and the fracture healing time. The self-maded miniature traction eternal fixator is worthy to be popularied.