交锁髓内钉联合阻挡螺钉固定治疗单侧胫骨干中下段骨折的疗效

Analysis of the efficacy and safety of interlocking intramedullary nail closed and nailing com-bined with blocking screw for treatment of patients with unilateral tibial fracture

目的探讨交锁髓内钉闭合穿钉联合阻挡螺钉固定应用于单侧胫骨干中下段骨折患者的效果。方法选取我院单侧胫骨干中下段骨折患者178例(2017年4月~2019年6月),采用微创经皮钢板内固定术(MIPPO组)治疗的88例为MIPPO组,采用交锁髓内钉闭合穿钉联合阻挡螺钉固定治疗的90例为IMN+阻挡螺钉组(IMN+阻挡螺钉组)。比较两组优良率、手术及术后指标(术中出血量、手术时间、术后恢复时间、骨折愈合时间)、术前、术后3个月胫骨干Johner-Wruhs评分、踝关节Kofoed评分、膝关节Baily评分、术后并发症发生率。结果IMN+阻挡螺钉优良率96.67%高于MIPPO组84.09%,术后并发症发生率3.33%低于MIPPO组19.32%(P<0.05);IMN+阻挡螺钉组术中出血量多于MIPPO组组,手术时间长于MIPPO组,术后恢复时间、骨折愈合时间短于MIPPO组(P<0.05);术后3个月,IMN+阻挡螺钉组胫骨干Johner-Wruhs评分、踝关节Kofoed评分、膝关节Baily评分均高于MIPPO组(P<0.05)。结论交锁髓内钉闭合穿钉联合阻挡螺钉固定治疗单侧胫骨干中下段骨折,可提高优良率,改善胫骨干、踝关节、膝关节功能,降低并发症发生率,促进康复。

Objective To investigate the effect of interlocking intramedullary nailing and screwing combined with blocking screws on patients with unilateral tibial shaft fractures.Methods A total of 178 patients with unilateral and lower tibial shaft fractures in our hospital(April 2017 to June 2019)were se-lected,88 patients treated with minimally invasive percutaneous plate internal fixation(MIPPO)were used as the control group,and 90 patients treated with interlocking intramedullary nails and perforating screws combined with blocking screws were used as the observation group.The excellent and good rates,surgical and postoperative indicators(intraoperative blood loss,surgical time,postoperative recovery time,fracture healing time),Johner-Wruhs score of tibial shaft,Kofoed score of ankle joint,Baily score of knee joint before and after 3 months,and incidence of postoperative complications were com-pared between the two groups.Results The excellent rate in the observation group was 96.67%higher than the control group 84.09%,and the incidence of postoperative complications was 3.33%lower than the control group 19.32%(P<0.05);the intraoperative blood loss of the observation group was more than that of the control group,and the operation time was longer than that of the control group,the postopera-tive recovery time and fracture healing time were shorter than the control group(P<0.05);three months after operation,the Johner-Wruhs score of the tibial shaft,Kofoed score of the ankle joint,and Baily score of the knee joint in the observation group were higher than those in the control group(P<0.05).Conclusion Interlocking intramedullary nails combined with blocking screws for the treatment of unilat-eral tibial shaft fractures can improve the excellent rate,improve the function of tibial shaft,ankle and knee joints,reduce the incidence of complications and promote rehabilitation.