两种内固定方法治疗胫骨中下段骨折的疗效比较

Comparison effect of two internal fixation methods in the treatment of middle and distal tibial fracture

目的比较髓内钉与经皮微创钢板内固定治疗胫骨中下段骨折的临床疗效。方法将42例胫骨中下段骨折患者根据内固定方法不同分为髓内钉组(21例)和钢板组(21例),比较两组的手术时间、术中出血量、骨折愈合时间和并发症情况。结果 42例均获得随访,时间10~33个月。髓内钉组术中出血量显著多于钢板组,差异有统计学意义(P<0.05);髓内钉组的手术时间和骨折愈合时间均少于钢板组,但差异无统计学意义(P>0.05)。按Johner-Wruhs评分标准评价疗效,髓内钉组优16例,良2例,中2例,差1例,优良率18/21;钢板组优15例,良4例,中2例,差0例,优良率19/21,两组优良率比较差异无统计学意义(P>0.05)。钢板组术后并发症总发生率显著低于髓内钉组,差异有统计学意义(P<0.05)。结论对于胫骨中下段骨折的治疗,两种内固定方法都可以取得满意的临床疗效,但经皮微创钢板内固定的出血量更小、并发症更少。

Objective To compare the effect of intramedullary nailing and minimally invasive percutaneous plate os-teosynthesis in the treatment of middle and distal tibial fracture. Methods Forty-two patients with middle or distal tibial fractures were divided into intramedullary nailing group （21 patients） and plate group （21 patients） according to the treatment methods. The operative time, blood loss, bone union time and complications were compared between two groups. Results All 42 cases were followed up for 10 ？33 months. The blood loss in the plate group was signifi-cantly less than that in the intramedullary nailing group （ P 〈 0. 05 ） ; and intramedullary nailing group was less than plate group in operative time and bone union time, there were no significant difference between the two groups（P 〉 0. 05）. The Johner-Wruhs standard score was excellent in 16 cases, good in 2 cases, and fair in 2, and poor in 1, with an excellent and good rate of 18/21 in the intramedullary nailing group,and that was excellent in 15 cases, good in 4,and fair in 2, and poor in 0, with an excellent and good rate of 19/21 in the plate group, there was no statisticaldifference between two groups （ P 〉 0. 05 ）. The total complications incidence rate in the plate group was significantly lower than that in the intramedullary nailing group （P 〈 0. 05 ） . Conclusions The clinical effect of intramedullary nailing and minimally invasive percutaneous plate osteosynthesis in the middle and distal tibial fracture are all satis-factory. However, the minimally invasive percutaneous plate osteosynthesis has advantages of less blood loss and less complications.