弹性髓内钉与接骨板内固定治疗成人盖氏骨折的对照研究

A comparative study of titanium elastic intramedullary nail internal fixation and bone plate internal fixation in the treatment of adult Galeazzi fracture

目的探讨钛制弹性髓内钉微创内固定与切开复位接骨板内固定治疗成人盖氏骨折的疗效差异。方法采用前瞻性队列研究方法,将2012年1月—2015年11月收治并符合选择标准的97例盖氏骨折患者分为两组,其中59例采用切开复位接骨板内固定(接骨板组),38例采用微创钛制弹性髓内钉内固定(微创组)。两组患者性别、年龄、致伤原因、骨折部位、骨折类型及受伤至手术时间等一般资料比较差异无统计学意义(P>0.05)。记录两组手术时间、术中出血量、骨折愈合时间及并发症发生情况,采用Anderson评分标准评估前臂功能。结果两组患者均获随访,随访时间12～23个月,平均17个月。微创组患者手术时间、术中出血量、骨折愈合时间均显著少于接骨板组,差异有统计学意义(P<0.05)。接骨板组发生骨折不愈合1例、伤口感染1例,微创组发生钉尾处轻微感染1例,均经相应处理后治愈;其余患者骨折均愈合,无血管神经损伤、内固定失败、深部感染等并发症发生。术后12个月根据Anderson评分评价前臂功能,接骨板组获优46例,良12例,差1例,优良率98.3%;微创组获优26例,良11例,可1例,优良率97.4%;两者比较差异无统计学意义(χ~2=0.10,P=0.75)。结论钛制弹性髓内钉内固定治疗盖氏骨折具有损伤小、恢复快、无切口瘢痕等优点,在适应证选择正确的基础上,可获较好临床效果。

Objective To explore the effectiveness difference between titanium elastic intramedullary nail internal fixation and bone plate internal fixation in the treatment of adult Galeazzi fracture. Methods Ninety-seven patients of Galeazzi fracture according with the selection criteria were divided into 2 groups by prospective cohort study, who were admitted between January 2012 and November 2015. In the patients, 59 were treated with open reduction and bone plate internal fixation （plate group）, and 38 with titanium elastic intramedullary nail internal fixation （minimally invasive group）. There was no significant difference in the gender, age, cause of injury, fracture site, type of fracture, and time from injury to operation between 2 groups （P〉0.05）. The operation time, intraoperative blood loss, fracture healing time, and complications were recorded and compared between 2 groups, and the forearm function was evaluated by Anderson score. Results All the patients were followed up 12-23 months （mean, 17 months）. The operation time, intraoperative blood loss, fracture healing time of minimally invasive group were significantly less than those in plate group （P〈0.05）. There were 1 case of fracture nonunion, 1 case of wound infection in plate group, and 1 case of nail tail slight infection in minimally invasive group, which were all cured after the corresponding treatment, The remaining patients had good fracture healing, and no vascular injury, internal fixation failure, deep infection, or other complications occurred. According to Anderson score at 12 months after operation, the forearm function results were excellent in 46 cases, good in 12 cases, and poor in 1 case, with an excellent and good rate of 98.3% in plate group; and the results were excellent in 26 cases, good in 11 cases, and poor in 1 case, with an excellent and good rate of 97.4% in minimally invasive group; showing no significant difference （X2=0,10, P=0.75）. Conclusion Minimally invasive fixation with titanium elastic nail has such advantages as small damage, quick recovery, no skin scarring, etc. As long as the correct indication is selected, minimally invasive titanium intramedullary nail internal fixation of Galeazzi fractures can also get good effectiveness.