带锁髓内钉与钢板固定治疗胫骨干骨折的疗效比较

Comparison of interlocking intramedullary nail and plate fixation used in tibial shaft fracture

目的对比带锁髓内钉与钢板固定治疗胫骨干骨折的优缺点。方法回顾性分析自2012年1月至2017年1月在本院确诊为胫骨干骨折的患者167例,依据手术方式将其分为带锁髓内钉组(80例)与钢板固定组(87例)。收集两组患者以下指标:一般情况、手术时间、住院时间、骨痂出现时间、愈合时间、患者负重时间、术后内固定物取出时间、术中失血量、手术相关并发症、手术疗效,并进行比较。结果两组患者一般情况差异无统计学意义,髓内钉组与钢板固定组手术时间[(100.21±12.33)minvs(125.32±14.41)min],术中失血量[(78.16±9.93)mlvs(137.17±12.94)ml],住院时间[(13.45±2.64)dvs17.53±3.41)d]、骨痂出现时间[(2.67±0.55)个月vs(3.34±0.64)个月]、愈合时间[(5.76±1.43)个月vs(7.03±1.89)个月]、负重时间[(3.01±0.72)个月vs(3.86±0.64)个月]、内固定物取出时间[(13.13±2.45)个月vs(17.24±2.86)个月],差异均有统计学意义(P<0.05)。髓内钉组手术相关并发症低于钢板固定组(2.5%vs9.2%),差异有统计学意义(P<0.05);手术总体有效率也同样存在显著性差异(98.8%vs86.2%),差异有统计学意义(P<0.05)。结论胫骨干骨折时采用带锁髓内钉治疗疗效比钢板固定更具有优势,值得在临床中推广。

Objective To compare the advantages and disadvantages of interlocking intramedullary nail and plate fixation in the treatment of tibial shaft fractures.Methods 167 patients with tibial shaft fracture diagnosed in our hospital from January 2012 to January 2017 were retrospectively analyzed.They were divided into interlocking intramedullary nail group(80 cases)and plate fixation group(87 cases).The following indicators were collected:general condition,operation time,intraoperative blood loss,hospitalization time,callus appearance time,healing time,patients'weightbearing time,removal time of internal fixator after operation,operation-related complications and operation efficacy,and were compared between the two groups.Results There was no significant difference in general condition between the two groups.The operation time of intramedullary nail group and plate fixation group was[(100.21±12.33)min vs(125.32±14.41)min],intraoperative blood loss[(78.16±9.93)ml vs(137.17±12.94)ml],hospitalization time[(13.45±2.64)d vs(17.53±3.41)d],callus appearance time[(2.67±0.55)months vs(3.34±0.64)months].The healing time[(5.76±1.43)months vs(7.03±1.89)months],weight-bearing time[(3.01±0.72)months vs(3.86±0.64)months]and removal time of internal fixator[(13.13±2.45)months vs(17.24±2.86)months]were significantly different.The complications related to operation in intramedullary nailing group were lower than those in plate fixation group(2.5%vs 9.2%),the difference was statistically significant(P<0.05).The overall effective rate of operation was also significantly different(98.8%vs 86.2%),the difference was statistically significant(P<0.05).Conclusion Interlocking intramedullary nail is more effective than plate fixation in the treatment of tibial shaft fracture,and it is worth popularizing in clinical practice.