带锁髄内钉与钢板置入内固定治疗胫骨骨折的效果比较

Application of locking intramedullary nail and locking plate in traumatic extraarticular proximal tibiai fractures

目的 比较带锁髓内钉与钢板置入内固定在关节外胫骨创伤性骨折治疗中的应用效果。方法 选取关节外胫骨创伤性骨折患者150例为研究对象，根据内固定方案不同分为观察组与对照组各75例。观察组采用多功能带锁髓内钉固定，对照组采用锁定钢板固定，比较两组骨折修复效果、术中出血量、手术时间、出血时间及并发症发生情况。结果 观察组平均骨折愈合时间为（9.17±2.84）个月，对照组为（9.25±2.65）个月，两组差异无统计学意义（t＝0.252，P〉0.05）。观察组修复效果明显优于对照组，差异有统计学意义（u＝4.341，P〈0.05）。观察组手术时间较对照组长[（99.73±26.31）min比（83.18±13.94）min]、出血量较对照组少[（101.15±21.26）mL比（253.57±23.14）mL]、出血时间较对照组短[（44.25±15.63）min比（63.47±16.09）min]，差异均有统计学意义（t＝4.814、42.006、7.420，均P〈0.05）。观察组神经血管损伤、外翻及内翻发生率均低于对照组，差异均有统计学意义（2＝3.857、5.042、4.807，均P〈0.05）。观察组不愈合及感染发生率均低于对照组，但差异均无统计学意义（χ2＝1.027、1.714，均P〉0.05）。结论 多功能带锁髓内钉固定治疗关节外胫骨创伤性骨折出血量少，并发症发生率较低，骨折修复效果明显优于钢板置入内固定。

Objective To investigate the application of locking intramedullary nail and locking plate in traumatic extraarticular proximal tibial fractures.Methods 150 patients with traumatic extraarticular proximal tibial fractures were chosen in the research.According to the internal fixation program,the patients were divided into observation group and control group,with 75 cases in each group.The observation group was treated with multifunctional locking intramedullary nail,the control group was treated with locking plate.After treatment for 3 months,the fracture repairing effects,blood loss,operation time,bleeding duration and adverse reaction between the two groups were compared.Results The patients were followed up after operation,the average fracture healing time of the observation group was（9.17±2.84）months,which of the control group was（9.25±2.65）months,there was no statistically significant difference between the two groups（t=0.252,P〉0.05）.The repairing effect of the observation group was better than that of the control group,the difference was statistically significant（u=4.341,P〈0.05）.The operation time[（99.73±26.31）min vs.（83.18±13.94）min]of the observation group was longer than that of the control group,blood loss[（101.15±21.26）mL vs.（253.57±23.14）mL]and bleeding duration[（44.25±15.63）min vs.（63.47±16.09）min]of the observation group were lower than those of the control group,the differences were statistically significant（t=4.814,42.006,7.420,all P〈0.05）.The incidence rates of nerve and vascular injuries,valgus and varus of the observation group were lower than those of the control group,the differences were statistically significant（χ2=3.857,5.042,4.807,all P〈0.05）.The incidence rates of unhealing and infection in the observation group were lower than those in the control group,but the differences were not statistically significant（χ2=1.027,1.714,all P〉0.05）.Conclusion Multifunctional locking intramedullary nail can reduce the incidence rate of adverse reaction and blood loss in traumatic extraarticular proximal tibial fractures,the fracture repairing effect is better than locking plate internal fixation.