闭合胫骨髓内针与微创经皮解剖锁定钢板治疗胫骨中下段骨折的临床疗效比较

Clinical efficacy of closed tibial intramedullary nail and minimally invasive percutaneous anatomical locking plate in the treatment of middle and lower tibial fractures

目的:通过临床治疗效果来分析闭合胫骨髓内针与微创经皮解剖锁定钢板治疗胫骨中下段骨折的差异,为选择合适固定方式治疗胫骨中下段骨折提供依据.方法:回顾性分析2010年1月-2015年12月于我院因胫骨中下段骨折手术治疗的患者70名,按选择固定材料的不同分为髓内针组38例和钢板组32例.对比2种不同固定方式在术中辐射量、术中失血量、手术时间;术后骨折愈合时间、术后并发症例数、术后12个月的踝关节kofoed评分方面的统计学差异.结果:70例患者术后均获得12-20个月(平均18个月)随访.闭合胫骨髓内针与微创经皮解剖锁定钢板组患者术中指标比较情况,2组患者术中辐射量(15.4±3.3)次和(14.4±2.8)次、术中失血量(148.5±18.8)ml和(143.7±17.1)ml、术中手术时间(74.7±15.4)分钟和(72.6±20.1)分钟比较,无统计学意义(P>0.05);闭合胫骨髓内针与微创经皮解剖锁定钢板组患者术后指标比较情况,2组患者术后骨折愈合时间(86.6±3.9)天和(125.6±5.7)天、术后并发症例数1例和8例、术后12个月的踝关节kofoed评分(90.8±5.2)分和(80.4±6.3)分比较,有统计学意义(P<0.05).结论:闭合胫骨髓内针治疗胫骨中下段骨折比较微创经皮解剖锁定钢板组,术中指标无明显差别,术后具有骨折愈合时间短、并发症例数少、术后12个月的踝关节kofoed评分高的优点,值得在临床中推广.

Objective:To analyze the difference between closed tibial intramedullary nail and minimally invasive percutaneous anatom-ical locking plate in the treatment of middle and lower tibial fractures through clinical treatment,and to provide basis for selecting appro-priate fixation methods for the treatment of middle and lower tibial fractures.Methods:From January 2010 to December 2015,70 patients with fracture of middle and lower tibia were retrospectively analyzed.They were divided into intramedullary nail group(38 cases)and plate group(32 cases)according to the choice of fixation materials.The differences of radiation,blood loss,operation time,fracture healing time,complications and ankle kofoed score between the two fixation methods were compared.Results:70 patients were followed up for 12 to 20 months(average 18 months).There were no significant differences in intraoperative parameters between closed tibial intr-amedullary nail group and minimally invasive percutaneous anatomical locking plate group(P>0.05).There were no significant differ-ences between closed tibial intramedullary nail group and minimally invasive percutaneous anatomical locking plate group(P>0.05).Postoperative indicators in the plate group were compared:the healing time of fracture(86.6+3.9)and(125.6+5.7),the number of complications(1)and(8),the kofoed score of ankle joint(90.8+5.2)and(80.4+6.3)were significantly different between the two groups(P<0.05).Conclusion:Closed tibial intramedullary nail in the treatment of middle and lower tibial fractures was a mini-mally invasive percutaneous anatomical locking plate group.There was no significant difference in operative indicators.It had the advanta-ges of short fracture healing time,fewer complications and high kofoed score of ankle 12 months after operation.It was worth popularizing in clinical practice.