交锁与旋入式自锁髓内钉两种固定方案治疗胫骨新鲜闭合性骨折的临床观察

Clinical observation of two kinds of fixation schemes of interlocking and rotary self-locking intramedullary nail for the treatment of closed fresh tibial fractures

目的对交锁与旋入式自锁髓内钉两种固定方案治疗胫骨新鲜闭合性骨折的临床效果进行探讨。方法 74例胫骨新鲜闭合性骨折患者,随机分为对照组和研究组,各37例。对照组采用交锁髓内钉固定方案治疗,研究组采用旋入式自锁髓内钉固定方案治疗。对比两组临床相关指标及并发症情况。结果研究组手术时间、术中出血量、术中透视次数、骨折愈合时间分别为(35.3±12.4)min、(84.3±20.5)ml、(5.3±2.7)次、(13.4±2.3)周,对照组分别为(52.4±17.6)min、(127.1±31.2)ml、(11.5±3.5)次、(16.3±3.7)周;研究组手术时间、术中出血量、术中透视次数、骨折愈合时间均优于对照组,差异有统计学意义(P<0.05)。研究组切口感染、骨延迟愈合各1例,并发症发生率为5.41%(2/35);对照组切口感染、肢体缩短、术后松动、骨延迟愈合分别为1、1、2、2例,并发症发生率为16.22%(6/35);研究组并发症发生率略低于对照组,差异无统计学意义(P>0.05)。结论相较于交锁髓内钉固定方案,旋入式自锁髓内钉治疗胫骨新鲜闭合性骨折更能够改善患者临床指标,有广泛使用的必要。

Objective To investigate the clinical effect of two kinds of fixation schemes of interlocking and rotary self-locking intramedullary nail for the treatment of closed fresh tibial fractures. Methods A total of 74 patients with closed fresh tibial fractures were randomly divided into control group and research group, with 37 cases in each group. The control group was treated with interlocking intramedullary nail, and the research group was treated with rotary self-locking intramedullary nail. Comparison were made on clinical related indicators and complications condition between two groups. Results The research group had operation time, intraoperative bleeding volume, intraoperative fluoroscopy times and fracture healing time respectively as（35.3±12.4） min,（84.3±20.5） ml,（5.3±2.7） times and（13.4±2.3） weeks, which were（52.4±17.6） min,（127.1±31.2） ml,（11.5±3.5） times and（16.3±3.7） weeks. The research group had better operation time, intraoperative bleeding volume, intraoperative fluoroscopy times and fracture healing time than the control group, and their difference was statistically significant（P〈0.05）. The research group had 1 case of incision infection and 1 case of delayed bone healing, with incidence of complications as 5.41%（2/35）. The control group had number of incision infection, limb shortening, postoperative loosening and delayed bone healing respectively as 1, 1, 2 and 2 cases, with incidence of complications as 16.22%（6/35）. The research group had lower incidence of complications than the control group, but the difference was not statistically significant（P〉0.05）. Conclusion Compared with interlocking intramedullary nail regimen, rotary self-locking intramedullary nail can improve the clinical indicators of patients with closed fresh tibial fractures, and it is necessary to use it extensively.