髓内钉和锁定钢板治疗中青年胫骨远端闭合性骨折合并软组织损伤的疗效评价

Evaluation of intramedullary nail and locking plate in the treatment of closed fracture of distal tibia combined with soft tissue injury in young and middle-aged people

目的比较胫骨髓内钉(intramedullary nail,IMN)与胫骨远端锁定钢板(locked plate,LP)治疗中青年胫骨远端闭合性骨折合并软组织损伤的临床疗效。方法回顾性分析2010年1月至2018年12月大连大学附属中山医院收治的152例中青年胫骨远端闭合性骨折合并软组织损伤患者的临床资料,根据治疗方法的不同分为IMN组(84例,采用胫骨IMN内固定治疗)和LP组(68例,采用胫骨远端LP内固定治疗)。比较两组的手术时间、住院时间、感染发生率、骨折愈合情况、患肢康复情况,并应用Olerud-Molander踝关节评分(OM评分)评价术后患肢功能。结果两组的手术时间、住院时间、感染发生率、骨折愈合情况比较差异无显著性(P>0.05)。两组患者均未发生骨不连。IMN组患肢完全负重时间和软组织损伤愈合时间明显短于LP组,差异有显著性(P<0.05)。OM评分显示,IMN组术后患肢功能62例为优、22例为良,LP组44例为优、24例为良,两组比较差异无显著性(P>0.05)。结论中青年胫骨远端闭合性骨折合并软组织损伤采用IMN与LP治疗均能获得理想的治疗效果以及良好的关节功能,且IMN内固定术后完全负重时间和软组织损伤愈合时间相对较短,值得临床推广。

Objective To compare and analyze the clinical efficacy of intramedullary nail(IMN)and locked plate(LP)in the treatment of closed fracture of distal tibia combined with soft tissue injury in young and middle-aged people.Method A total of 152 young and middleaged patients with closed fracture of distal tibia combined with soft tissue injury who were admitted to our clinic from January 2010 to December 2018 were retrospectively analyzed.84 patients were treated with IMN,68 patients were treated with LP.Postoperative follow-up was carried out to observe the related conditions of the two groups,including the average operation time,the mean union time,the infection rate,the time of full weight bearing,healing time of soft tissue injury and the rate of malunion and nonunion.The function of the injured limb was evaluated with the Olerud–Molander Ankle Score system.Result There was no significant difference in operative time,hospital time,infection rate,union time and postoperative functional recovery between the two groups.No bone nonunion occurred in two groups.62 patients in IMN group and 44 patients in LP group achieved excellent curative effect,22 patients in IMN group and 24 patients in LP group achieved good curative effect.Compared with group LP(15.2±1.9 weeks;14.6±1.5 days),the time of full weight bearing and healing time of soft tissue injury were significantly shortened in group IMN(12.8±1.1 weeks;12.2±1.1 days),and the difference was statistically significant(P<0.05).Conclusion Both IMN and LP can acquire expected therapeutic effect and joint function in the treatment of closed fracture of distal tibia combined with soft tissue injury in young and middle-aged people.The time of full weight bearing and healing time of soft tissue injury of IMN is relatively short,and the treatment is worth promoting.