弹性髓内针与钢板螺钉治疗腓骨干骨折的比较研究

Internal fixation with elastic intramedullary nail versus plate-screw system for treatment of fibular diaphyseal fracture

目的比较弹性髓内针与钢板螺钉治疗腓骨干骨折的疗效。方法回顾性分析2014年1月至2017年4月48例胫腓骨骨折内固定治疗的患者资料，根据腓骨干于术方式不同分为弹性髓内针（EIN）组（采用弹性髓内针内固定，21例）和钢板螺钉组（采用钢板螺钉内固定，27例），比较两组术中固定腓骨时的出血量、手术时间、腓骨骨折愈合时间、腓骨骨折愈合率、美国足踝外科协会（AOFAS）的踝一后足评分及术后并发症发生率等。结果所有患者术后获3～24个月（平均14．0个月）随访。EIN组腓骨内固定手术的出血量[（17．9±4．9）mL]、腓骨手术时间[（23．2±5．8）min]及骨折愈合时间[（10．3±1．8）周]较钢板螺钉组[（28．9±9．6）mL、（30．0±10．7）min、（11．6±2．0）周]少，差异均有统汁学意义（P〈0．05）。两组腓骨骨折愈合率（95．2％vs．92．6％）、切口感染率（0 vs 7．4％）比较差异均尢统计学意义（P〉0．05）。AOFAS的踝-后足评分：EIN组：优12例，良8例，中1例，平均（91．0±5．3）分；钢板螺钉组：优14例，良10例，中3例，半均（90．1±6．1）分，两组评分比较差异无统计学意义（P=0．594）。结论与钢板螺钉比较，EIN治疗腓骨干骨折具有出血量少、手术时间短、骨折愈合时间短等优势，但在提高骨折愈合率及改善踝关节功能方面并无显著优势。

Objective To compare elastic intramedullm7 nail （EIN） and plate-screw （P ＋ S） system in the treatment of fibular diaphyseal fractures. Methods From January 2014 to April 2017, 48 tibiofibular fractures were treated with internal fixation using EIN （21 cases） or plate-screw （27 cases）. The 2 groups were compared in terms of intraoperative blood loss, operative time, fibular healing time, fibular union rate, ankle function and postoperative complications. Results All the patients were followed up for 3 to 24 months （average, 14.0 months）. The intraoperative blood loss （17.9± 4.9 mL）, operative time （23.2 ± 5.8 min） anti fibular healing time （ 10.3 ± 1.8 weeks） for the EIN group were significantly less than those for the plate-screw group （28.9 ± 9.6 mL, 30.0 ± 10.7 rain and 11.6 ±2.0 weeks） （ P 〈 0.05）. There were no significant differences between the 2 groups in fibular union rate （95.2% versus 92.6% ） or incision infection （0 versus 7.4% ） （ P 〉 0.05） ] The AOFAS ankle-hindfoot scoring revealed 12 excellent, 8 good and one fair cases （91.0± 5.3 points on aver- age） in the EIN group, and 14 excellent, 10 good anti 3 fair cases （90. 1 ±6. 1 points on average） in the plate-screw group, showing no significant difference between the 2 groups（ P = 0. 594） . Conclusions Compared with plate-screw system, elastic intramedullaPy nail for fibular diaphyseal fractures may he in line with the biome- chanieal characteristics of the fibula and with the basic principles of minimally invasive surgery. It may be advantageous in blood loss, operative time and fracture healing but not in fibular union rate or functional recovery of the ankle. An appropriate way of internal fixation for a fibular diaphyseal fracture should be chosen according to the specific conditions of the patient.