经皮锁定钢板与交锁髓内钉治疗胫骨干节段性骨折临床疗效比较

Comparison of clinical effects between percutaneous locking plate and interlocking intramedullary nail in treating segmental tibial shaft fracture

目的比较使用微创经皮锁定钢板内固定(MIPPO)和交锁髓内钉内固定(IMN)治疗胫骨干节段性骨折患者的临床疗效。方法选取江苏大学附属人民医院和苏北人民医院41例胫骨节段性骨折内固定患者为研究对象,其中MIPPO组22例,IMN组19例,随访1年。比较两组患者术中出血量、总失血量(术前及术后第1天血红蛋白差值)、骨折愈合时间、术后开始负重时间、术后并发症发生率、术后1年Johner-Wruhs功能评分等临床数据,以评估两组患者的治疗效果。结果IMN组与MIPPO组比较,患者骨折愈合时间更早[(17.39±2.10)周vs.(19.34±3.22)周,P<0.05],术后开始负重时间也更早[(6.93±1.04)周vs.(8.71±1.38)周,P<0.05)],总失血量更多[(32.89±6.55)g/L vs.(18.36±4.27)g/L,P<0.05]。两组术中出血量比较,差异无统计学意义[(99.33±31.62)mL vs.(87.34±24.15)mL,P=0.18)]。IMN组畸形愈合1例,向前成角8°,感染1例,并发症发生率为10.53%。MIPPO组骨不连3例,感染2例,并发症发生率为22.73%。两组患者并发症发生率及术后1年Johner-Wruhs功能评分优良率比较,差异无统计学意义(P>0.05)。结论IMN能提供更坚强的固定,骨折愈合时间更短,可早期负重功能锻炼,是治疗胫骨节段性骨折更好的选择。

Objective To compare the clinical effects of minimally invasive percutaneous plate osteosynthesis(MIPPO)and interlocking intramedullary nail(IMN)internal fixation in the treatment of segmental tibial shaft fractures.Methods A total of 41 patients with segmental tibial shaft fractures in the Affiliated People’s Hospital of Jiangsu University and Northern Jiangsu People’s Hospital were selected as the study subjects,including 22 cases in the MIPPO group and 19 cases in the IMN group.All patients were followed up for 1 year.The clinical data such as the intraoperative bleeding volume,total blood loss volume(the difference value of hemoglobin before operation and on postoperative 1 d),postoperative early loading time,fracture healing time,incidence rate of postoperative complications and Johner Wruhs functional score in postoperative 1 year were compared between the two groups.Results Compared with the MIPPO group,the fracture healing time in the IMN group was shorter[(17.39±2.10)weeks vs.(19.34±3.22)weeks,P<0.05)],postoperative loading time was early[(6.93±1.04)weeks vs.(8.71±1.38)weeks,P<0.05],total blood loss volume was greater[(32.89±6.55)g/L vs.(18.36±4.27)g/L,P=0.177)],but the intraoperative average blood loss had no statistical difference between the two groups[(99.33±31.62)mL vs.(87.34±24.15)mL,P=0.177].There was 1 case of malunion with a forward angle of 8°in the IMN group,1 case of infection,and the incidence rate of complications was 10.53%.In the MIPPO group,there were 3 cases of bone nonunion,2 cases of infection and the incidence rate of complications was 22.73%.The complication incidence rate and the excellent and good rate of Johner Wruhs functional score in postoperative 1 year had no statistical difference between the two groups.Conclusion IMN could provide the stronger fixation,shorter fracture healing time,and early weight bearing functional exercise,which is the better choice for treatment of segmental tibial fractures.