髓内钉微创治疗对胫腓骨多段骨折患者临床疗效的影响

Effect of minimally invasive treatment of intramedullary nail on the clinical efficacy of patients with multi-segment fractures of tibia

目的探讨髓内钉微创治疗对胫腓骨多段骨折的临床疗效。方法回顾性分析我院2016年9月-2017年9月收治的100例胫腓骨多段骨折患者临床资料,根据手术方式分为观察组(50例)和对照组(50例),观察组采取闭合复位微创交锁髓内钉内固定术,对照组采取切开复位普通钢板内固定术。比较两组患者手术时间,切口长度,术中出血量,住院时间,骨折愈合时间、术后并发症发生率及踝关节功能评分。结果观察组患者手术时间、术后引流时间、住院时间及骨折愈合时间均短于对照组,术中出血量较对照组少,切口较对照组短,差异均有统计学意义(P<0.05)。观察组患者术后1、3、6个月Mazur评分及踝关节功能优良率均高于对照组,差异有统计学意义(P<0.05)。术后6个月,观察组与对照组临床总有效率分别为92.0%和68.0%,差异有统计学意义(P<0.05)。观察组与对照组术后并发症发生率分别为10.0%和28.0%,差异有统计学意义(P<0.05)。治疗前两组膝关节活动度(伸、屈)无统计学差异,治疗后观察组均高于对照组,差异有统计学意义(P<0.05)。结论闭合复位交锁髓内钉微创术具有操作时间短、创伤小、骨折愈合快、手术并发症少等优点,用于胫腓骨多段骨折的治疗可促进关节功能恢复,临床疗效确切,值得推广。

Objective To investigate the clinical effect of intramedullary nail minimally invasive treatment on multi-segment fractures of tibia and fibula.Methods A retrospective analysis of the clinical data of 100 patients with multi-segment fractures of the tibia and fibula admitted to our hospital from September 2016 to September 2017 were divided into observation group(50 cases)and control group(50 cases)according to the operation method.Closed reduction and minimally invasive interlocking intramedullary nail internal fixation,the control group underwent open reduction and ordinary plate internal fixation.The operation time,incision length,intraoperative blood loss,hospitalization time,fracture healing time,postoperative complication rate and ankle function score were compared between the two groups.Results The observation group of patients with operation time,postoperative drainage time,hospitalization time and fracture healing time is shorter than the control group,intraoperative blood loss less than the control group,incision is the shorter of the control group,the difference had statistical significance(P<0.05).In the observation group,the scores of Mazur score and ankle function were higher than those of the control group in 1,3 and 6 months after surgery,and the difference was statistically significant(P<0.05).Six months after the operation,the total clinical efficiency of the observation group and the control group was 92.0%and 68.0%,respectively,and the difference was statistically significant(P<0.05).The incidence of postoperative complications in the observation group and the control group was 10.0%and 28.0%,respectively,and the difference was statistically significant(P<0.05).There was no significant difference in knee motion(extension and flexion)between the two groups before treatment,but there was significant difference between the observation group and the control group after treatment(P<0.05).Conclusion Closed reduction interlocking intramedullary nail microsurgery has the advantages of short operation time,small trauma,quick healing and less complications.The treatment of multiple fractures of tibia and fibula can promote the recovery of joint function.