侧卧双反牵引髌下入路髓内钉固定治疗胫骨干骨折

Application of Lateral Position and Homeopathic Double Reverse Traction Device forInfra-patellar Intramedullary Nailing in Treatment of Tibial Shaft Fractures

比较侧卧双反牵引髌下入路及传统髌下入路髓内钉固定治疗胫骨干骨折的疗效及预后。方法:回顾性分析我院2019年4月-2020年3月收治且获完整随访的43例胫骨干骨折患者资料,分为观察组(侧卧双反牵引组22例)和对照组(21例)。记录、对比2组患者手术时间、术中2次移位率、切开复位发生率、术中透视时间、术中失血量、末次随访时踝关节美国足踝外科协会踝-后足评分、骨折愈合时间、术后感染发生率等。结果:43例患者术后获得12-16个月(平均13.5个月)随访。2组患者术后一般资料比较差异无统计学意义。观察组和对照组术中出血量分别为(124.9±7.6)ml、(120.8±8.1)ml,末次随访时踝关节美国足踝外科协会踝-后足评分分别为(92.8±2.6)分、(91.3±3.4)分,骨折愈合时间分别为(24.1±1.8)周、(25.4±2.9)周,观察组术后感染发生1例(4.5%)、对照组为2例(9.5%),比较差异均无统计学意义(P﹥0.05)。观察组手术时间为(118.5±2.0)分钟、术中“2次移位”率为2例(9.1%)、术中切开复位率1例(4.5%)、透视时间为(2.1±0.1)秒,均明显少于对照组的(124.9±1.8)分钟、9例(42.9%)、7例(33.3%)、(2.6±0.1)秒,差异均有统计学意义(P<0.05)。结论:胫骨干骨折行髓内钉固定治疗时,侧卧双反牵引髌下入路较传统髌下入路操作更便捷,可减少术中透视时间,降低术中2次移位、切开复位发生率,缩短手术时间,不增加术后感染风险,可获得患者满意的手术效果。

To compare the clinical efficacy and prognosis between lateral position and homeo-pathic double reverse traction device for infra-patellar and classical infra-patellar intramedullary nailing in treatment of tibial shaft fractures.Methods:A retrospective analysis was conducted of 43 patients with tibial shaft fractures who had been treated from April 2019 to March 2020 and completed follow-up.They were as-signed to lateral position and homeopathic double reverse traction group(group A,n=22)and traditional group(group B,n=21).The two groups were compared in terms of operation time,second intraoperative shifting rate,open reduction rate,intraoperative fluoroscopy time,intraoperative bleeding volume,the American Ortho-pedic Foot&Ankle Society(AOFAS)ankle-hind-foot score,fracture healing time and postoperative infec-tion rate.Results:43 patients were followed up for 12-16 months(mean 13.5 months).There were no sig-nificant differences in general data between the two groups(P﹥0.05).There were no significant differences between the two groups in the amount of intraoperative bleeding volume(124.9±7.6ml VS 120.8±8.1ml),AOFAS foot scores(92.8±2.6 VS 91.3±3.4),fracture healing time(24.1±1.8 weeks VS 25.4±2.9 weeks),postoperative infection rate(1 case,4.5%VS 2 cases,9.5%).The operation time(118.5±2.0min),second intraoperative shifting rate(2 cases,9.1%),open reduction rate(1 case,4.5%)and intraop-erative fluoroscopy time(2.1±0.1s)in group A were significantly shorter than those in group B[(124.9±1.8min),(9 cases,42.9%),(7 cases,33.3%)and(2.6±0.1s)](P<0.05).Conclusion:Lateral position and homeopathic double reverse traction device for infra-patellar is more convenient than the traditional infra-patellar intramedullary nailing in treatment of tibial shaft fractures,which couled reduce intraoperative fluoroscopy time,intraoperative shifting rate and open reduction rate,shorten the operation time,and didnt in-crease the risk of postoperative infection,and couled achieve satisfactory results.