两种内固定方式治疗胫骨多段骨折的疗效比较

Comparison of two internal fixation methods for multiple segment tibial shaft fractures

[目的]比较应用交锁髓内钉与钢板内固定治疗胫骨多段骨折的临床疗效。[方法]回顾性分析2013年1月~2017年12月在本院行手术治疗的胫骨多段骨折共39例患者的临床资料。根据手术方式不同分为交锁髓内钉组(21例)和钢板组(18例)。记录两组的手术时间,术中出血量及术后引流量,骨折愈合时间及并发症发生情况。末次随访时按照Johner-Wruhs胫骨干骨折疗效评估标准对患者功能进行评价。[结果]两组患者均顺利完成手术,术中均未出现肢体血管神经损伤。髓内钉组手术时间、切口总长度和术中失血量均显著优于钢板组,差异有统计学意义(P<0.05)。所有患者随访11~22个月,平均(13.67±4.76)个月。钢板组有2例术后因感染或骨不连行翻修术,而髓内钉组无翻修病例。髓内钉组开始负重行走时间和完全负重行走时间均显著早于钢板组(P<0.05);末次随访时髓内钉组的膝伸屈、踝背伸和踝跖屈ROM均显著大于钢板组(P<0.05);末次随访时按Johner-Wruhs标准评定临床效果,髓内钉组优14例,良6例,可1例,优良率95.23%;钢板组优10例,良5例,可1例,差2例,优良率83.33%。两组差异无统计学意义(P>0.05)。[结论]对于胫骨多段骨折,两种手术方式均能取得良好的临床疗效。但髓内钉可以更早负重,并发症发生率更低。

[Objective]To compare the clinical outcomes of multi-segment tibial shaft fractures treated by the intramedul lary nail versus plate.[Methods]A retrospective study was made on 39 patients who received surgical treatment for multiple segment tibial shaft fractures in our hospital from January 2013 to December 2017.Based on the internal fixation used,21 pa tients had fractures fixed with interlocking intramedullary nails,while the remaining 18 patients underwent minimally invasive percutaneous plating osteosynthesis(MIPPO)with plates.The operation time,intraoperative bleeding volume,postoperative drainage volume,knee and ankle range of motion fracture,fracture healing time and complications were compared between the two groups,additionally,Johner-Wruhs criteria was used for evaluating the clinical consequences.[Results]All the patients in both groups had surgical procedures performed smoothly,without iatrogenic neurovascular injuries.The nail group proved signif icantly superior to the plate group regarding to operation time,total incision length and intraoperative blood loss(P<0.05).The patients were followed up for 11~22 months with an average of(13.67±4.76)months.Revision surgeries was conducted in 2 pa tients of the plate group due to infection or nonunion,whereas no anyone in the nail group.The patients in nail group returned to partial and complete weight bearing ambulation significantly earlier than those in the plate group(P<0.05).At the latest follow up,the nail group had significantly greater knee and ankle ROM than the plate group(P<0.05).In term of Johner-Wruhs crite ria,the clinical outcomes were graded as excellent in 14,good in 6 and fair in 1 with excellent and good rate of 95.23%in the nail group,whereas excellent in 10,good in 5,fair in 1 and poor in 2 with excellent and good rate of 83.33%in the plate group,regardless of no a statistical difference between the two groups(P>0.05).[Conclusion]For multi-segment tibial fractures,both surgical methods do achieve good clinical outcomes.Howev er,intramedullary nail has benefits of weight bearing earlier and less complications than the plate.