胫骨下段骨折内踝入路非扩髓动力髓内固定与钢板固定的对照研究

A comparison study of unreamed dynamic intramedullary nailing through medial malleolus and plate fixation for distal tibial fracture

目的 比较胫骨下段骨折内踝入路非扩髓动力髓内固定与钢板固定的效果。方法 5 0例胫骨下段骨折 ,随机分至内踝入路非扩髓动力髓内固定组 (A组 )与钢板固定组 (B组 )各 2 5例。平均随访 13个月 (8～2 4个月 ) ,观察骨折愈合、并发症、术后处理、肢体功能情况。结果 骨折愈合时间 :A组 10～ 4 0 (19 0 4±5 2 3)周 ,B组 16～ 4 8(2 1 92± 7 97)周 ,P =0 137。延迟愈合 :A组 1例 ,B组 7例 ,P =0 0 2 1;两组均无骨不连。感染 :A组 1例 ,B组 2例 ,P =0 5 5 2。术后局部不适或疼痛 :A组 10例 (4 0 % ) ,B组 2例 (8% ) ,P =0 0 0 8。术后辅助石膏固定 :A组 2例 ,B组全部 ,P <0 0 0 1。石膏固定时间 :A组 0～ 30 (2 0 4± 7 18)d ,B组5 0～ 10 0 (6 9± 12 9)d ,P =0 0 2 1。术后去除或更换石膏 :A组 4次 ,B组 5 4次 ,P <0 0 0 1。早期负重 :A组 3～ 2 1(7 5± 5 2 4 )d ,B组 10～ 4 0 (2 1 4 4± 7 6 3)d ,P <0 0 0 1。膝关节屈曲 :A组 135～ 14 5 (14 0± 3 4 4 )° ,B组70～ 14 5 (12 4± 2 0 4 3)° ,P <0 0 0 1。踝关节背伸 :A组 17～ 2 5 (2 2 16± 2 5 4 )° ,B组 0～ 2 5 (15 96± 7 89)° ,P<0 0 0 1。结论 胫骨下段骨折内踝入路动力髓内固定是一值得临床探讨的方法 。

Objective To compare the effect of unreamed dynamic intramedullary nailing through medical malleolus and plat fixation for distal tibial fracture. Methods 50 cases of distal tibial fracture were divided randomly into two groups. Group A(25 cases) were treated with unreamed dynamic intramedullary nailing through medial malleolus incision, Group B(25 cases) with plating. All cases were followed up for 8～24 months(13 on average). The fracture healing, complication, postoperative treatment and the extremity function were observed. The results were treated with SPSS 11.0 software system. Results The fracture healing time was 10～40 (19.04±5.23) weeks in Group A and 16～48 (21.92±7.97) weeks in Group B, the difference was not significant(P=0.137). The delayed union rate was 1/25 in Group A and 7/25 in Group B and had significant difference(P=0.021). No nonunion occurred. The infection rate was 1/25 in Group A and 2/52 in Group B, which was not significant different(P=0.552). The uncomfort or pain complaint rate was 40% (10 case) in Group A and 8% (2 cases) in Group B, which had significant different(P=0.008). The postoperative plaster immobilization rate was 2/52 in Group A and 25/25 in Group, which had significant difference(P<0.001). The plaster immobilization time was 0～3 (2.04±7.18) d in Group A and 50～100 (69±12.9) d in Group B, and has significant difference (P=0.021). The times of changing plaster was 4 in Group A and 54 in Group B, and had significant difference (P<0.001). The weight bearing beginning time was 3～21 (7.5±5.24) d in Group A and 10～40(21.44±7.63) d in Group B and had significant difference(P<0.001). The range of knee flexion was 135～145 (140±3.44)° in Group A and 70～145 (124±20.43)° in Group B, and had significant difference (P<0.001). The range of ankle dorsal flexion was 17～25(22.16±2.54)° in Group A and 0～25(15.96±7.89)° in Group B and had significant difference(P<0.001). Conclusion It is a method deserved to be investigated in clinical practice in the treatment of distal tibial fracture with unreamed dynamic intramedullary nailing through medial malleolus incision, which needs less postoperative treatment and has less complication.