两种内固定术治疗胫骨下段AO分型42-A型骨折的疗效分析

Clinical Analysis of Two Internal Fixation Techniques in the Treatment of AO Type 42-A Fractures of the Lower Tibia

目的探讨交锁髓内钉与经皮微创锁定接骨板两种内固定技术治疗胫骨下段AO分型42-A型骨折的临床疗效。方法选取2017年6月至2021年5月池州市人民医院收治的70例胫骨下段AO分型42-A型骨折患者,随机分为A组、B组,分别采用交锁髓内钉技术及经皮微创锁定接骨板技术治疗。A组34例,其中男25例,女9例;年龄26~67岁,平均(50.38±10.08)岁。B组36例,其中男23例,女13例;年龄18~66岁,平均(46.69±11.11)岁。记录并比较两组患者住院时间、手术时间、术中出血量、骨折愈合时间、术后完全负重时间、术后并发症发生率及术后不同阶段Olerud-Molander踝关节评分、Lysholm膝关节评分。结果A组患者的手术时间、术中出血量均多于B组(P<0.05),而两组患者的住院时间、骨折愈合时间及完全负重时间比较,差异均无统计学意义(P>0.05);术后半个月、6个月及12个月,A组和B组Olerud-Molander踝关节评分比较,差异无统计学意义(P>0.05);术后半个月Lysholm膝关节评分比较,A组评分明显低于B组(P<0.05),而术后6个月、12个月两组Lysholm膝关节评分比较,差异无统计学意义(P>0.05);两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论交锁髓内钉与经皮微创锁定接骨板两种内固定技术治疗胫骨下段AO分型42-A型骨折效果差异不大,交锁髓内钉治疗手术时间、术中出血量略多,临床应用过程中医师可根据对两种技术掌握的熟练程度灵活选择。

Objective To investigate the clinical efficacy of interlocking intramedullary nail and percutaneous minimally invasive locking plate in the treatment of AO type 42-A fractures of the lower tibia.Methods 70 patients with AO type 42-A fracture of the lower tibia treated in the People’s Hospital of Chizhou from June 2017 to May 2021 were randomly divided into group A and group B.They were treated with interlocking intramedullary nail and percutaneous minimally invasive locking plate respectively.There were 34 patients in group A,including 25 males and 9 females,with an average age of(50.38±10.08)years,ranging from 26 to 67 years.Group B had 36 cases,including 23 males and 13 females,aged 18~66 years,with an average age of(46.69±11.11)years.The hospitalization time,operation time,intraoperative blood loss,fracture healing time,postoperative complete weight-bearing time,postoperative complication rate,Olerud Molander ankle score and Lysholm knee score at different stages were recorded and compared between the two groups.Results The operation time and intraoperative blood loss in group A were more than those in group B(P<0.05),but there was no significant difference in hospitalization time,fracture healing time and complete weight-bearing time between the two groups(P>0.05).There was no significant difference in Olerud Molander ankle score between group A and group B at half a month,6 months and 12 months after operation(P>0.05).The Lysholm knee score in group A was significantly lower than that in group B half a month after operation(P<0.05),but there was no significant difference between the two groups at 6 and 12 months after operation(P>0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion There is little difference between the two internal fixation techniques of interlocking intramedullary nail and percutaneous minimally invasive locking plate in the treatment of AO type 42-A fractures of the lower tibia.The operation time and intraoperative bleeding volume of interlocking intramedullary nail are slightly more.In the process of clinical application,surgeons can flexibly choose according to the proficiency of the two techniques.