动态锁定螺钉结合钢板内固定治疗胫骨骨折的疗效

Efficacy of dynamic locking screw combined with plate internal fixation for tibial fractures

目的评价动态锁定螺钉结合钢板内固定治疗胫骨骨折的效果。方法采用回顾性病例对照研究分析2017年3月—2018年3月陆军军医大学第二附属医院收治的36例胫骨骨折(AO 4A-C)患者的临床资料;其中男27例,女9例;年龄26~71岁[(51.6±14.3)岁]。18例采用动态锁定螺钉+锁定钢板内固定治疗(A组),18例采用普通锁定螺钉+锁定钢板内固定治疗(B组)。比较两组手术时间、术中出血量、术后住院时间及术后4,8,12,24周视觉模拟评分(VAS)、骨痂生长情况和骨折愈合率。同时评估内固定并发症情况,包括螺钉松动、螺钉断裂和钢板断裂情况。结果36例患者均获随访8~18个月[(12.2±2.7)个月]。两组手术时间、术中出血量、术后住院时间及术后VAS比较差异均无统计学意义(P>0.05)。术后8,12周时,A组骨痂生长率分别为61%和83%,显著高于B组的28%和50%(P<0.05);术后8,12,24周时,A组骨折愈合率分别为17%、50%和100%,B组为6%、28%和89%,两组差异无统计学意义(P>0.05)。随访中均未发现与动态锁定螺钉直接相关的并发症或内固定失效。结论锁定钢板内固定治疗胫骨骨折均可获得满意的临床疗效,但动态锁定螺钉系统可促进骨折断端早期骨痂生长。

Objective To evaluate the efficacy of dynamic locking screw combined with plate internal fixation for tibial fractures.Methods A retrospective case-control study was conducted to analyze the clinical data of 36 patients with tibial fractures(AO 4A-C)admitted to the Second Affiliated Hospital of Army Medical University from March 2017 to March 2018.There were 27 males and nine females,aged 26-71 years[(51.6±14.3)years].A total of 18 patients were treated with dynamic locking screw combined with locking plate internal fixation(Group A),and another 18 patients received common locking screw combined with locking plate internal fixation(Group B).The operation time,intraoperative bleeding,hospital stay,visual analogue score(VAS),callus growth and fracture healing rate at 4,8,12 and 24 weeks after operation were compared between the two groups.At the same time,the complications of internal fixation were evaluated,including screw loosening,screw fracture and steel plate fracture.Results All the patients were followed up for 8-18 months[(12.2±2.7)months].There was no significant difference in operation time,intraoperative bleeding,postoperative hospital stay and postoperative VAS between the two groups(P>0.05).At 8 and 12 weeks after operation,the callus growth rate of Group A was 61% and 83% respectively,significantly higher than those of Group B(28% and 50%)(P<0.05).At 8,12,and 24 weeks after operation,the fracture healing rate of Group A was 17%,50% and 100% respectively,and those of Group B was 6%,28% and 89%,showing no significant difference between the two groups(P>0.05).No complications or failure of internal fixation were found during the follow-up.Conclusion For tibial fractures,the locking plate internal fixation can achieve satisfactory clinical outcome,but the dynamic locking screw system can promote the growth of callus at early stage.