阻挡钉快速置入技术与传统髓内钉固定术治疗等速肌力训练期胫骨近端干性骨折的疗效比较

Comparison of the curative effect between the rapid insertion technique of barrier nail and traditional intramedullary nail fixation for proximal tibial shaft fractures

目的比较分析阻挡钉快速置入技术与传统髓内钉固定术治疗等速肌力训练期胫骨近端干性骨折的疗效。方法回顾性选取2016年1月至2019年11月唐山市第二医院收治的48例胫骨近端干性骨折患者作为研究对象,2组均接受等速肌力训练。采用传统髓内钉固定术者23例(传统组),采用阻挡钉快速置入技术者25例(阻挡组)。观察并记录2组患者临床疗效、疼痛视觉模拟量表(VAS)评分、术后胫骨断端矢状面及冠状面成角、围手术期指标及骨折愈合时间等临床数据,然后进行统计学分析。结果传统组优良率为86.96%,阻挡组优良率为92.00%,2组优良率比较差异无统计学意义(P> 0.05)。2组术后VAS评分均显著下降(P <0.05),阻挡组术后1、3个月VAS评分为(3.67±0.85)、(2.61±0.73)分,明显低于传统组[(4.97±1.03)、(4.01±0.89)分],差异均有统计学意义(P <0.05),但2组术后6个月和末次随访的VAS评分比较[(1.53±0.68)分vs.(1.63±0.74)分,(1.14±0.61)分vs.(1.21±0.65)分],差异均无统计学意义(P> 0.05)。阻挡组术后胫骨断端矢状面和冠状面成角为(2.71±0.42)°、(2.93±0.91)°,均明显大于传统组[(1.39±0.37)°、(2.28±0.69)°],差异均有统计学意义(P <0.05)。阻挡组手术时间和透视次数为(125.83±35.63) min、(110.31±24.80)次,均明显多于传统组[(82.97±20.47) min、(28.68±9.36)次],住院时间、术中出血量及骨折愈合时间分别为(7.15±2.63) d、(91.43±19.87) mL、(3.07±0.74)个月,均明显少于传统组[(9.35±3.58) d、(143.75±37.89) mL、(4.13±0.95)个月],差异均有统计学意义(P <0.05)。结论对胫骨近端干性骨折,阻挡钉快速置入技术与传统髓内钉固定术的临床疗效相当,但各有优缺点。阻挡钉快速置入技术在减轻患者术后早期疼痛和减少住院时间、术中出血量及骨折愈合时间上更具优势,但对手术操作人员的技能要求过高;传统髓内钉固定术虽对手术操作人员的技能要求不甚高,但因术后早期疼痛、住院时间及骨折愈合时间长、术中出血量大,患者医疗成本相对较高,临床应基于实际情况酌情选择。

Objective To comparative analyze the effect of fast insertion of blocking nail and traditional intramedullary nail fixation in the treatment of proximal tibial dry fracture.Methods From January 2016 to November 2019,48 patients with proximal tibial fractures admitted to the Tangshan Second Hospital were retrospectively selected as the research objects,both groups received isokinetic training.23 patients who used traditional intramedullary nail fixation(traditional group),and those who used the rapid insertion technique of barrier nails 25 cases(blocking group).The clinical efficacy,visual analog scale(VAS)score,sagittal and coronal angulation of tibial fracture,perioperative indexes and fracture healing time of the two groups were observed and recorded.Results The excellent and good rate was 86.96%in the traditional group and 92.00%in the blocking group.There was no significant difference between the two groups(P>0.05).The VAS scores of the two groups were significantly decreased(P<0.05).The VAS scores of the blocking group were(3.67±0.85)and(2.61±0.73)points at 1 and 3 months after operation,which were significantly lower than those of the traditional group[(4.97±1.03),(4.01±0.89)points],and the differences were statistically significant(P<0.05),but there was no significant difference in the VAS scores of the two groups after 6 months and the last follow-up[(1.53±0.68)points vs.(1.63±0.74)points(1.14±0.61)points vs.(1.21±0.65)points](P>0.05).The sagittal and coronal angles of the tibial stump in the blocking group were(2.71±0.42)°and(2.93±0.91)°,which were significantly greater than those in the traditional group[(1.39±0.37)°,(2.28±0.69)°],the differences were statistically significant(P<0.05).The operation time and the number of fluoroscopy in the blocking group were(125.83±35.63)min and(110.31±24.80)times,which were significantly more than the traditional group[(82.97±20.47)min,(28.68±9.36)times],and the hospitalization time,intraoperative blood loss and fracture healing time were(7.15±2.63)d and(91.43±19.87)mL(3.07±0.74)months,respectively,which were significantly less than those in the traditional group[(9.35±3.58)d,(143.75±37.89)mL(4.13±)0.95)month],the differences were statistically significant(P<0.05).Conclusion For proximal tibial dry fractures,the rapid insertion technique of barrier nails has the same clinical efficacy as traditional intramedullary nail fixation,but each has advantages and disadvantages.The rapid insertion technique of barrier nails has advantages in reducing early postoperative pain,reducing hospitalization time,intraoperative blood loss,and fracture healing time,but it requires too much skill for surgical operators.Although traditional intramedullary nail fixation does not require very high skills for the surgical operator,but due to early postoperative pain,long hospital stay and fracture healing time,and large intraoperative blood loss,the patient's medical cost is relatively high.The clinical practice should be based on reality.Choose according to circumstances.