交锁髓内钉固定与锁定钢板内固定治疗胫腓骨骨折的效果比较

Comparison of therapeutic effects of interlocking intramedullary nail fixation and locking plate internal fixation on tibiofibular fractures

目的比较交锁髓内钉固定与锁定钢板内固定治疗胫腓骨骨折的效果。方法队列研究。抽取2021年7月至2022年8月于河南宏力医院进行胫腓骨骨折手术患者50例。根据内固定材料将其分为A组(25例,采用交锁髓内钉固定)与B组(25例,采用锁定钢板内固定)。比较两组围术期相关指标(手术时间、术中出血量、骨痂出现及骨折愈合时间)、手术疗效。比较两组手术前后微循环状态指标、膝关节功能评分、力学稳定性。结果两组手术时间比较差异未见统计学意义(P>0.05);B组术中出血量少于A组,A组骨痂出现及骨折愈合时间短于B组(P<0.05)。术前及术后7 d,两组足甲襞微循环积分、毛细血管流速比较差异未见统计学意义(P>0.05);术后3 d,A组足甲襞微循环积分低于B组,毛细血管流速高于B组(P<0.05)。术后1、6个月,A组Rasmussen膝关节功能评分高于B组(P<0.05)。术后12个月,A组Rasmussen解剖学评分高于B组(P<0.05)。A组手术优良率(96.00%,24/25)高于B组(76.00%,19/25),P<0.05。结论交锁髓内钉固定治疗胫腓骨骨折的手术疗效理想,可维持骨折端力学稳定性,对下肢微循环影响较小,安全性高。

Objective To investigate the effects of interlocking intramedullary nail fixation and locking plate internal fixation in the treatment of tibiofibular fracture surgery.Methods A total of 50 patients who underwent tibiofibular fracture surgery in Henan Honliv Hospital from July 2021 to August 2022 were selected for the cohort study.And they were divided into group A(25 cases,treated by interlocking intramedullary nail fixation)and group B(25 cases,treated by locking plate internal fixation)according to internal fixation materials.The perioperative related indexes(operation duration,intraoperative blood loss,time for callus formation,and fracture healing time),and surgical efficacy of the two groups were compared.The preoperative and postoperative microcirculatory status indexes,knee joint function scores,and mechanical stability were compared between the two groups.Results There was no significant difference in operation duration between the two groups(P>0.05).The intraoperative blood loss in the group B was less than that in the group A(P<0.05).The time for callus formation and fracture healing time in the group A were shorter than those in the group B(P<0.05).Before and 7 days after surgery,there was no significant difference in the nailfold videocapillaroscopy score,capillary velocity rate between the two groups(P>0.05).Three days after surgery,the nailfold videocapillaroscopy score in the group A was lower than that in the group B,whlile capillary velocity rate in the group A was higher than that in the group B(P<0.05).The Rasmussen knee joint function score in the group A was higher than that in the group B 1 and 6 months after surgery(P<0.05).The Rasmussen anatomical scores in the group A was higher than that in the group B 12 months after operation(P<0.05).The excellent and good rate of operation in the group A(96.00%,24/25)was significantly higher than that in the group B(76.00%,19/25),P<0.05.Conclusions Interlocking intramedullary nail fixation has an ideal therapeutic effect and high safety in ibiofibular fractures surgery,which can maintain the mechanical stability of the fracture,with little impact on the microcirculation of the lower limb and high safety.