摘要
目的比较闭合复位交锁髓内钉和微创经皮钢板内固定治疗胫骨中下段骨折的疗效及安全性。方法回顾性分析2015年1月~2017年9月我科收治的90例胫骨中下段骨折患者的临床资料,分别采用闭合复位交锁髓内钉(IMN组)和微创经皮钢板内固定治疗(MIPPO组),每组45例。比较两组患者手术切口长度、术中出血量、手术时间、术后下地时间;术后完成1年随访,观察骨折愈合时间、愈合率和术后3个月、6个月骨痂生长和末次随访行Johner-Wruhs评分,同时观察并发症发生情况。结果通过术中及术后各项指标(手术时间、手术切口长度、术中出血量和术后下地时间)分析表明髓内钉(IMN)组均优于微创钢板(MIPPO)组(P<0.05)。IMN组3个月、6个月可见骨痂生长及术后1年骨折愈合百分比高于MIPPO组,平均骨折愈合时间低于MIPPO组(P<0.05)。IMN组末次随访Johner-Wruhs评分优良率高于MIPPO组(P<0.05)。IMN组延迟愈合1例,随访期间未愈合1例,发生率为4.44%;MIPPO组术后感染1例,延迟愈合2例,膝关节疼痛2例,畸形愈合2例,发生率为15.56%。IMN组发生率低于MIPPO组(P<0.05)。结论在治疗胫骨中下段骨折时,髓内钉和钢板均可以选择,相比之下,IMN能够更好的保护骨折断端骨膜及其血供,力学稳定性好,可作为首先推荐的手术方式。
Objective To compare the efficacy and safety of closed reduction and interlocking intramedullary nails and minimally invasive percutaneous plate internal fixation for the treatment of middle and lower tibial fractures.Methods The clinical data of 90 patients with middle and lower tibial fractures treated in our department from January 2015 to September 2017 were retrospectively analyzed.They were treated with closed reduction and interlocking intramedullary nails(IMN group,n=45)and minimally invasive percutaneous plate internal fixation(MIPPO group,n=45)respectively.The incision length of operation,intraoperative blood loss,operation time and postoperative ambulation time were compared between the two groups.One year follow-up was completed after surgery.The fracture healing time,healing rate and the number of epiphyseal growth at 3 and 6 months after surgery were observed.Johner-Wruhs score was performed last follow-up.And the complication was observed.Results According to the intraoperative and postoperative indicators(operation time,incision length of operation,intraoperative blood loss,and postoperative ambulation time)analysis,the IMN group was better than that in the MIPPO group(P<0.05).In the IMN group,the number of epiphyseal growth cases at 3 months and 6 months and the percentage of fracture healing at 1 year after operation were higher than those in the MIPPO group,and the average fracture healing time was lower than that in the MIPPO group(P<0.05).The excellent follow-up rate of Johner-Wruhs score in the IMN group during the last follow-up was higher than that in the MIPPO group(P<0.05).One patient in the IMN group had delayed healing,and one patient did not heal during follow-up,with the incidence of 4.44%.One patient in the MIPPO group had postoperative infection,two patients had delayed healing,two had knee pain,and two had abnormal healing,with the incidence of 15.56%.The incidence of IMN group was lower than that of MIPPO group(P<0.05).Conclusion In the treatment of middle and lower tibial fractures,both intramedullary nails and steel plates can be selected.In contrast,IMN can better protect the periosteum of the fracture and its blood supply,and it has good mechanical stability.It can be used as first recommended surgical approach.
作者
张鑫
李军
许新忠
ZHANG Xin;LI Jun;XU Xinzhong(Department of Orthopaedics,the Second Affiliated Hospital of Anhui Medical University,Hefei230000,China)
出处
《中国现代医生》
2020年第6期81-85,共5页
China Modern Doctor
基金
安徽省自然科学基金青年项目(1708085QH221)
安徽省合肥市自主创新政策“借转补”项目(YW201608080006)
安徽省卫生计生委中医药科研课题项目(2016zy92)
安徽省重点研究与开发计划项目(201904b11020032)。
关键词
经皮微创钢板
交锁髓内钉
胫骨骨折
闭合复位
Percutaneous minimally invasive steel plate
Interlocking intramedullary nail
Tibial fracture
Closed reduction
