微创锁定接骨板与髓内钉治疗闭合性胫骨骨折疗效比较

An Effect Comparison of Minimally Invasive Locking Plate and Intramedullary Nail in the Treatment of Closed Tibial Fracture

目的比较微创锁定接骨板与髓内钉内固定治疗闭合性胫骨中下段骨折的临床效果。方法选取江苏省中西医结合医院骨伤科和南京市江宁区中医院骨伤科在2015年4月—2018年4月收治的闭合性胫骨干中下段骨折患者共57例,其中采用微创锁定接骨板治疗31例,髓内钉治疗26例,从手术时间、出血量、术后切口愈合情况、骨折愈合时间、功能恢复情况对两组进行比较。对所有患者随访12~24个月,平均16.3个月。结果接骨板组有1例出现延迟愈合,但1年后随访,骨折达到骨性愈合,髓内钉组全部愈合,接骨板组术后1例出现内踝处切口局部皮肤坏死,约4周后愈合,两组均未出现切口感染病例,髓内钉组1例出现膝关节伸直活动受限,1年后取出髓内钉后,经功能锻炼膝关节伸直功能恢复,接骨板组和髓内钉组功能评估,踝关节功能优良率分别为91.9%、91.4%,膝关节功能优良率分别是97.3%、78.6%。两组在手术时间、出血量、骨折愈合时间上差异无统计学意义(P>0.05),切口愈合情况髓内钉组优于接骨板组,功能恢复情况踝关节功能评分差异有统计学意义(P<0.05),膝关节功能评分接骨板组优于髓内钉组(主要表现在髓内钉组对膝关节功能有影响,而接骨板组对膝关节无任何影响)。结论微创锁定接骨板和髓内钉治疗胫骨闭合性胫骨中下段骨折,各有优缺点,但均取得满意疗效,选择何种方法治疗,取决于术者习惯及技术水平。

Objective To compare the clinical efficacy of minimally invasive locking plate and intramedullary nailing in the treatment of closed distal tibial shaft fracture.Methods From April 2015 to April 2018,57 consecutive patients with closed distal tibial shaft fracture from department of orthopaedics and traumatology in Jiangsu Province Hospital of Integrated Traditional Chinese and Western Medicine and Nanjing Jiangning District Hospital of Traditional Chinese Medicine surgically treated were selected,among them,31 patients were treated by minimally invasive locking plate while 26 patients were treated by intramedullary nailing.Operative time,blood loss,wound healing,fracture healing time,functional recovery were observed.All patients were followed up for 12~24 months,with an average of 16.3 months.Results 1 case in the plate group was delayed union while it reached osseous union after 1 years follow-up,the cases in the intramedullary nailing group totally got osseous union.1 case in the plate group had local skin necrosis in medial malleolus which got healing after 4 weeks,no incision infection occurred in both groups,1 case in the intramedullary nailing group suffered disfunction of knee extention which recovered after intramedullary nailing remove 1 years later.In ankle joint function assessment,clinical excellent and good rate was 91.9%in the plate group and 91.4%in the intramedullary nailing group,while in knee joint function assessment,clinical excellent and good rate was 97.3%in plate group and 78.6%in intramedullary nailing group.There was no statistically significant difference between the two groups in operative time,blood loss and fracture healing time(P>0.05),wound healing of intramedullary nailing group was better than that of the plate group,functional recovery of ankle function score in both group had no statistical significance,the knee joint function score was better in the plate group than that in the intramedullary nail group(mainly due to the damage to knee joint in the intramedullary nailing group).Conclusion Both minimally invasive locking plate and intramedullary nailing in the treatment of closed distal tibial shaft fracture have advantages and disadvantages,and obtain satisfactory surgical effect.How to choose the surgical method depends on the habits and skill level of the surgeon.