交锁髓内钉固定术对胫腓骨骨折患者围手术期指标及关节功能的影响

Effect of Interlocking Intramedullary Nail Fixation on Perioperative Indexes and Joint Function of Patients with Tibiofibular Fracture

目的:探讨交锁髓内钉固定术对胫腓骨骨折患者围手术期指标及关节功能的影响。方法:选取九江市第三人民医院2020年6月-2022年6月收治的胫腓骨骨折患者60例,按随机数字表法分为对照组和观察组,各30例。对照组行锁定钢板内固定术治疗,观察组行交锁髓内钉固定术治疗,术后随访6个月。比较两组围手术期指标、关节功能[骨关节炎指数(WOMAC)]、Oswestry功能障碍指数(ODI)评分、日常生活能力[Barthel指数(BI)]、关节活动度、平衡功能[Berg平衡量表(BBS)及Fugl-Meyer平衡量表(FM-B)]、生活质量及并发症发生情况。结果:观察组住院时间、骨痂出现时间及骨折愈合时间[(11.32±1.42)d,(5.12±1.13)、(17.25±1.43)周],均短于对照组[(14.28±1.54)d,(5.89±1.16)、(19.32±1.55)周],差异均有统计学意义(P<0.05);观察组术后6个月WOMAC中日常生活、疼痛、关节僵硬及总分为(17.49±1.48)、(2.41±0.42)、(0.68±0.13)、(20.58±3.19)分,均低于对照组的(22.15±2.32)、(3.32±0.52)、(0.92±0.15)、(26.39±3.28)分,差异均有统计学意义(P<0.05);观察组术后6个月ODI评分为(12.75±1.23)分,低于对照组的(13.94±1.39)分,BI评分为(87.96±6.35)分高于对照组的(80.47±6.24)分,差异均有统计学意义(P<0.05);观察组术后6个月膝关节伸直、屈曲度、BBS评分、FM-B评分[(6.78±0.65)°、(123.72±8.46)°、(40.79±4.09)分、(11.22±1.43)分],均高于对照组[(6.24±0.59)°、(115.59±7.43)°、(35.62±3.52)分、(9.35±1.29)分],差异均有统计学意义(P<0.05);观察组术后6个月生理、心理、社会及环境领域评分为(87.06±6.25)、(88.61±6.34)、(90.29±4.22)、(91.05±4.16)分均高于对照组的(79.72±6.12)、(81.42±6.29)、(82.89±6.53)、(83.82±6.08)分,并发症发生率低于对照组,差异均有统计学意义(P<0.05)。结论:交锁髓内钉固定术治疗胫腓骨骨折效果更佳,可加快关节功能恢复,改善下肢活动能力,且并发症少,有助于提升术后生活质量。

Objective:To investigate the effect of interlocking intramedullary nail fixation on the perioperative indexes and joint function of patients with tibiofibular fractures.Method:A total of 60 patients with tibiofibular fractures admitted to Third People's Hospital of Jiujiang City from June 2020 to June 2022 were randomly divided into the control group and the observation group with 30 cases each.The control group was treated with locking plate internal fixation,and the observation group was treated with interlocking intramedullary nail fixation.The follow-up was 6 months after operation.Perioperative indexes,joint function[Western Ontario and McMaster(WOMAC)universities osteoarthritis index],Oswestry dysfunction index(ODI)score,daily living ability[Barthel index(BI)],joint activity,balance function[Berg balance scale(BBS)and Fugl-Meyer balance scale(FM-B)],quality of life and complications were compared between the two groups.Result:The hospitalization time,callus occurrence time and fracture healing time[(11.32±1.42)days,(5.12±1.13)and(17.25±1.43)weeks]of the observation group were shorter than those of the control group[(14.28±1.54)days,(5.89±1.16)and(19.32±1.55)weeks],with statistical differences(P<0.05).The scores of daily life,pain,joint stiffness and total score in WOMAC were(17.49±1.48),(2.41±0.42),(0.68±0.13)and(20.58±3.19)points in the observation group 6 months after operation were lower than(22.15±2.32),(3.32±0.52),(0.92±0.15)and(26.39±3.28)points in the control group,with statistical differences(P<0.05).The ODI score of the observation group was(12.75±1.23)points 6 months after operation,lower than(13.94±1.39)points of the control group,BI was(87.96±6.35)points,higher than(80.47±6.24)points of the control group,with statistical differences(P<0.05).The knee joint straightening,flexion,BBS score and FM-B score[(6.78±0.65)°,(123.72±8.46)°,(40.79±4.09)points,(11.22±1.43)points]6 months after operation in the observation group were significantly higher than those in the control group[(6.24±0.59)°,(115.59±7.43)°,(35.62±3.52)points and(9.35±1.29)points],with statistical differences(P<0.05).The scores in the fields of physiology,psychology,society and environment were(87.06±6.25),(88.61±6.34),(90.29±4.22),(91.05±4.16)points in the observation group 6 months after operation were higher than(79.72±6.12),(81.42±6.29),(82.89±6.53)and(83.82±6.08)points in the control group,and the complications rate was lower than those in the control group(P<0.05).Conclusion:The effect of interlocking intramedullary nail fixation in the treatment of tibiofibular fracture is better,which can accelerate the recovery of joint function,improve the mobility of lower limbs,and has fewer complications,which is helpful to improve the quality of life after operation.