锁定加压钢板和交锁髓内钉内固定治疗胫骨远端关节外骨折疗效比较

Comparative analysis on clinical efficacy of locking compression plate fixation and interlocking intramedullary nailing fixation in the treatment of extra-articular fracture of the distal tibia

目的比较锁定加压钢板和交锁髓内钉内固定治疗胫骨远端关节外骨折的临床疗效。方法选取2015年1月至2017年1月在韶关市第一人民医院创伤手外科接受治疗的94例胫骨远端关节外骨折患者为研究对象,按照随机数表法将患者分为观察组和对照组,每组47例。观察组采用锁定加压钢板治疗,对照组采用交锁髓内钉治疗,比较两组患者的手术时间、术中出血量、住院时间和骨折愈合时间,统计两组治疗优良率,并记录术后并发症发生情况。结果观察组和对照组患者的手术时间[(68.5±7.4) min vs (95.1±8.90) min]、术中出血量[(109.3±11.9) mL vs (156.2±14.3) m L]和骨折愈合时间[(15.8±1.6)周vs (19.3±1.8)周]比较,观察组明显少于对照组,差异均有统计学意义(P<0.05),但两组患者的住院时间比较差异无统计学意义(P>0.05);观察组患者的治疗优良率为80.9%,与对照组的78.7%比较差异无统计学意义(P>0.05);观察组患者的总并发症发生率为8.5%,明显低于对照组的27.7%,差异有统计学意义(P<0.05)。结论锁定加压钢板和交锁髓内钉内固定治疗胫骨远端关节外骨折均可取得理想疗效。经皮锁定加压钢板手术时间短、术中出血少、术后愈合快,同时并发症少,值得临床推广应用。

Objective To compare the clinical efficacy of locking compression plate fixation and interlocking intramedullary nailing fixation in the treatment of extra-articular fracture of the distal tibia. Methods A total of 94 patients with extra-articular fracture of the distal tibia were selected as subjects, who underwent treatment in the Department of Traumatic Hand Surgery at the First People's Hospital of Shaoguan City from January 2015 to January 2017. The patients were divided into observation group and control group according to the random number table method, with 47 cases in each group. The observation group was given locking compression plate fixation, and the control group was treated with interlocking intramedullary nailing fixation. The operation time, intraoperative blood loss, hospitalization time and fracture healing time were compared between the two groups. The excellent and good rate of treatment was counted, and the incidence of postoperative complications was recorded. Results Comparison between the observation group and the control group on operation time, intraoperative blood loss, and fracture healing time showed that the observation group was significantly less than the control group, and all differences were statistically significant (P<0.05):(68.5±7.4) min vs (95.1±8.90) min,(109.3±11.9) mL vs (156.2±14.3) mL,(15.8±1.6) weeks vs (19.3±1.8) weeks. However, the difference in hospitalization time between the two groups was not statistically significant (P>0.05). The excellent and good rate in the observation group was 80.9%, which was not statistically significant compared with 78.7% in the control group (P>0.05). The total incidence of complications in the observation group was 8.5%, which was significantly lower than 27.7% in the control group (P<0.05). Conclusion Applying locking compression plate fixation and interlocking intramedullary nailing fixation can achieve ideal results in the treatment of extra-articular fracture of the distal tibia. Percutaneous locking compression plate fixation has shorter operation time, less intraoperative blood loss, faster postoperative healing, and less complications. It is worthy of clinical application.