[1]许胜贵,林成寿,郭卫中,等.4种内固定方式治疗胫骨远端近踝部骨折的对比研究[J].中医正骨,2026,38(03):44-51.
　XU Shenggui,LIN Chengshou,GUO Weizhong,et al.A comparative study of four internal fixation methods for distal tibial fractures near the ankle[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2026,38(03):44-51.
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4种内固定方式治疗胫骨远端近踝部骨折的对比研究()

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第38卷
期数:
2026年03期
页码:
44-51
栏目:
临床研究
出版日期:
2026-03-20

文章信息/Info

Title:
A comparative study of four internal fixation methods for distal tibial fractures near the ankle
作者:
许胜贵1; 林成寿1; 郭卫中1; 朱建非2; 石朋文2; 丁真奇3; 林需枰3; 刘庆军3
(1.福建医科大学附属闽东医院,福建 福安 355000; 2.淮安八二医院,江苏 淮安 223001; 3.中国人民解放军联勤保障部队第九〇九医院,福建 漳州 363000)
Author(s):
XU Shenggui1; LIN Chengshou1; GUO Weizhong1; ZHU Jianfei2; SHI Pengwen2; DING Zhenqi3; LIN Xuping3; LIU Qingjun3
1.Mindong Hospital Affiliated to Fujian Medical University,Fu'an 355000,Fujian,China; 2.Huai'an 82 Hospital,Huai'an 223001,Jiangsu,China; 3.The 909th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army,Zhangzhou 363000,Fujian,China
关键词:
胫骨骨折;  骨折固定术; 内;  内固定器;  骨板;  骨钉;  临床研究专题
Keywords:
tibial fractures;  fracture fixation; internal;  internal fixators;  bone plates;  bone nails;  clinical studies as topic
摘要:
目的:比较胫骨远端内侧锁定钢板(distal medial tibial locking plate,DMTLP)、胫骨远端外侧锁定钢板(distal lateral tibial locking plate,DLTLP)、胫骨逆行髓内钉(retrograde tibial intramedullary nail,RTN)及专家级胫骨髓内钉(expert tibial intramedullary nail,ETN)内固定治疗胫骨远端近踝部骨折的临床疗效与安全性。方法:回顾性分析2021年1月至2024年1月,在福建医科大学附属闽东医院、淮安八二医院和中国人民解放军联勤保障部队第九〇九医院接受内固定手术治疗的120例胫骨远端近踝部骨折患者的病例资料,其中DMTLP内固定35例、DLTLP内固定32例、RTN内固定27例、ETN内固定26例,按照内固定方式分为4组。比较4组患者的术前等待时间、手术时间、术中出血量、住院时间、术后部分负重时间、术后完全负重时间、骨折愈合时间及并发症发生情况,采用美国足与踝关节协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足评分标准评价临床综合疗效。结果:①手术一般情况。DMTLP组术前等待时间短于DLTLP组(P=0.047),二者的术前等待时间均长于RTN组和ETN组(P=0.000,P=0.000; P=0.000,P=0.000); RTN组术前等待时间短于ETN组(P=0.000)。DMTLP组手术时间短于DLTLP组(P=0.000)、长于RTN组(P=0.000),与ETN组的差异无统计学意义(P=0.076); DLTLP组手术时间长于RTN组和ETN组(P=0.000,P=0.002); RTN组手术时间短于ETN组(P=0.000)。DMTLP组术中出血量少于DLTLP组和ETN组(P=0.000,P=0.000),多于RTN组(P=0.000); DLTLP组术中出血量多于RTN组(P=0.000),与ETN组的差异无统计学意义(P=0.478); RTN组术中出血量少于ETN组(P=0.000)。DMTLP组住院时间与DLTLP组的差异无统计学意义(P=0.148),但二者的住院时间均长于RTN组和ETN组(P=0.000,P=0.000; P=0.000,P=0.000); RTN组住院时间短于ETN组(P=0.000)。②术后负重及骨折愈合时间。120例患者均获随访,随访时间12～18个月,中位数15个月。DMTLP组术后部分负重时间与DLTLP组、ETN组的差异均无统计学意义(P=0.086,P=0.213),晚于RTN组(P=0.000); DLTLP组术后部分负重时间晚于RTN组和ETN组(P=0.000,P=0.007); RTN组术后部分负重时间早于ETN组(P=0.038)。DMTLP组术后完全负重时间与DLTLP组的差异无统计学意义(P=0.563),二者均晚于RTN组和ETN组(P=0.006,P=0.050; P=0.001,P=0.014); RTN组完全负重时间与ETN组的差异无统计学意义(P=0.459)。4组骨折愈合时间比较,差异无统计学意义(F=1.148,P=0.333)。③临床综合疗效。末次随访时,临床综合疗效DMTLP组优30例、良3例、可2例,DLTLP组优28例、良2例、可2例,RTN组优26例、良1例,ETN组优24例、良1例、可1例; 4组临床综合疗效比较,差异无统计学意义(Z=2.315,P=0.510)。④安全性。DMTLP组发生切口感染2例、内固定物断裂1例、踝关节疼痛2例,DLTLP组发生切口感染1例、腓浅神经损伤1例、内固定物断裂2例,ETN组发生螺钉退出致骨折不愈合1例、膝关节疼痛2例,RTN组未发生上述并发症。4组并发症发生率比较,差异无统计学意义(χ2=3.862,P=0.277)。结论:DMTLP、DLTLP、ETN及RTN内固定治疗胫骨远端近踝部骨折的临床综合疗效和安全性相当; 但RTN内固定在缩短术前等待时间、手术时间、住院时间及实现术后早期负重方面更具有优势,且术中出血量最少。
Abstract:
Objective:To compare the clinical efficacy and safety of distal medial tibial locking plate(DMTLP),distal lateral tibial locking plate(DLTLP),retrograde tibial intramedullary nail(RTN),and expert tibial intramedullary nail(ETN)in the treatment of distal tibial fractures near the ankle.Methods:The clinical data of 120 patients with distal tibial fractures near the ankle who underwent internal fixation surgery at Mindong Hospital Affiliated to Fujian Medical University,Huai'an 82 Hospital,and the 909th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from January 2021 to January 2024 were retrospectively analyzed.According to the internal fixation method,the patients were divided into DMTLP group(35 cases),DLTLP group(32 cases),RTN group(27 cases),and ETN group(26 cases).The preoperative waiting time,operative time,intraoperative blood loss,hospital stay,postoperative partial weight-bearing time,postoperative full weight-bearing time,fracture healing time,and complications were compared among the four groups,and the comprehensive clinical efficacy was evaluated using the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score.Results:①General surgical conditions.The preoperative waiting time was shorter in the DMTLP group compared to DLTLP group(P=0.047),while it was longer in DMTLP group and DLTLP group compared to RTN group and ETN group(P=0.000,P=0.000; P=0.000,P=0.000),with shorter preoperative waiting time in RTN group compared to ETN group(P=0.000).The operative time was shorter in DMTLP group compared to DLTLP group(P=0.000),but longer compared to RTN group(P=0.000),with no significant difference compared to ETN group(P=0.076).Furthermore,the operative time was longer in DLTLP group compared to RTN group and ETN group(P=0.000,P=0.002),with shorter operative time observed in RTN group compared to ETN group(P=0.000).The intraoperative blood loss was less in DMTLP group compared to DLTLP group and ETN group(P=0.000,P=0.000),but more compared to RTN group(P=0.000).Furthermore,the intraoperative blood loss was more in DLTLP group compared to RTN group(P=0.000),with no significant difference compared to ETN group(P=0.478).In addition,the intraoperative blood loss was less in RTN group compared to ETN group(P=0.000).The hospital stay was similar between DMTLP group and DLTLP group(P=0.148),but it was longer in DMTLP group and DLTLP group compared to RTN group and ETN group(P=0.000,P=0.000; P=0.000,P=0.000),with shorter hospital stay observed in RTN group compared to ETN group(P=0.000).②Postoperative weight-bearing and fracture healing time.All 120 patients were followed up for 12-18 months with a median of 15 months.The difference in postoperative partial weight-bearing time between DMTLP group and DLTLP group or ETN group was not statistically significant(P=0.086,P=0.213),but it was later in DMTLP group compared to RTN group(P=0.000).Furthermore,the postoperative partial weight-bearing time was later in DLTLP group compared to RTN group and ETN group(P=0.000,P=0.007),with earlier postoperative partial weight-bearing time in RTN group compared to ETN group(P=0.459).The postoperative full weight-bearing time was similar between DMTLP group and DLTLP group(P=0.563),but both groups were later compared to RTN group and ETN group(P=0.006,P=0.050; P=0.001,P=0.014),with no significant difference observed between RTN group and ETN group(P=0.459).The fracture healing time did not differ significantly among the four groups(F=1.148,P=0.333).③Comprehensive clinical efficacy.At the final follow-up,the comprehensive clinical efficacy in the DMTLP group was excellent in 30 cases,good in 3 cases,and fair in 2 cases; in the DLTLP group,it was excellent in 28 cases,good in 2 cases,and fair in 2 cases; in the RTN group,it was excellent in 26 cases and good in 1 case; and in the ETN group,it was excellent in 24 cases,good in 1 case,and fair in 1 case.No significant differences in clinical outcomes were observed among the four groups(Z=2.315,P=0.510).④Safety.Complications included incision infection(2 cases),implant breakage(1 case),and ankle pain(2 cases)were found in DMTLP group; incision infection(1 case),superficial peroneal nerve injury(1 case),and implant breakage(2 cases)were observed in DLTLP group; fracture nonunion caused by screw back-out(1 case)and knee pain(2 cases)were experienced in ETN group; while the aforementioned complications were not observed in RTN group.The incidence of complications did not differ significantly among the four groups(χ2=3.862,P=0.277).Conclusion:DMTLP,DLTLP,ETN,and RTN internal fixation techniques demonstrate comparable overall clinical efficacy and safety in treatment of distal tibial fractures near the ankle.However,the RTN internal fixation offers advantages in shortening preoperative waiting time,operative time,and hospital stay,as well as facilitating early postoperative weight-bearing,with the least intraoperative blood loss.

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备注/Memo

备注/Memo:
基金项目:2021年福建省自然科学基金项目(2021J011448); 2024年度福建省自然科学基金联合资助项目(2024J011582)
通信作者:刘庆军 E-mail:lqjun175@163.com
(收稿日期:2025-09-02 本文编辑:杨雅)
更新日期/Last Update: 2026-03-20