[1]闫英杰,白丁文,贾刚,等.髓内钉联合辅助钢板内固定和微创经皮钢板内固定治疗难复性胫骨干骨折的比较研究[J].中医正骨,2023,35(04):17-22.
　YAN Yingjie,BAI Dingwen,JIA Gang,et al.A comparative study of intramedullary nail combined with auxiliary plate internal fixation and minimally invasive percutaneous plate internal fixation in the treatment of refractory tibial shaft fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2023,35(04):17-22.
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髓内钉联合辅助钢板内固定和微创经皮钢板内固定治疗难复性胫骨干骨折的比较研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期数:
2023年04期
页码:
17-22
栏目:
临床研究
出版日期:
2023-04-20

文章信息/Info

Title:
A comparative study of intramedullary nail combined with auxiliary plate internal fixation and minimally invasive percutaneous plate internal fixation in the treatment of refractory tibial shaft fractures
作者:
闫英杰; 白丁文; 贾刚; 杨林
(富平朱老二骨伤医院,陕西 富平 711700)
Author(s):
YAN Yingjie; BAI Dingwen; JIA Gang; YANG Lin
Fuping Zhulao'er Orthopaedic Hospital,Fuping 711700,Shaanxi,China
关键词:
胫骨骨折;  骨折固定术; 内;  髓内钉;  骨板;  回顾性研究
Keywords:
tibial fractures;  fracture fixation; internal;  intramedullary nail;  bone plates;  retrospective studies
摘要:
目的:比较髓内钉联合辅助钢板内固定和微创经皮钢板内固定治疗难复性胫骨干骨折的临床疗效和安全性。方法:回顾性分析41例难复性胫骨干骨折患者的病例资料,其中采用髓内钉联合辅助钢板内固定治疗22例(联合内固定组)、采用微创经皮钢板内固定治疗19例(微创经皮钢板内固定组)。比较2组患者的手术时间、术中出血量、术后引流量、住院时间、术后1个月胫骨冠状面和矢状面成角、下地行走时间、完全负重时间、骨折临床愈合时间、骨折骨性愈合时间、术后12个月膝关节活动度和综合疗效及并发症发生情况。结果:①一般指标。2组患者手术时间、术中出血量、术后引流量、住院时间比较,组间差异均无统计学意义[(75.65±12.51)min,(81.15±14.89)min,t=1.308,P=0.306;(210.54±42.36)mL,(220.85±30.56)mL,t=1.216,P=0.233;(120.65±20.73)mL,(130.34±25.47)mL,t=1.323,P=0.195;(10.28±2.52)d,(9.15±1.46)d,t=1.721,P=0.096]。②下肢力线评价指标。联合内固定组患者术后1个月胫骨冠状面成角和矢状面成角均小于微创经皮钢板内固定组(2.28°±0.85°,3.75°±1.92°,t=3.086,P=0.004; 2.45°±0.92°,3.58°±1.76°,t=2.517,P=0.018)。③骨折恢复情况评价指标。联合内固定组患者下地行走时间、完全负重时间均短于微创经皮钢板内固定组[(7.23±1.17)周,(8.15±1.58)周,t=2.033,P=0.048;(12.54±2.25)周,(14.15±2.74)周,t=2.036,P=0.049],术后12个月膝关节活动度大于微创经皮钢板内固定组(123.28°±10.26°,108.98°±15.46°,t=-3.432,P=0.002); 2组患者骨折临床愈合时间和骨性愈合时间比较,组间差异均无统计学意义[(16.25±2.48)周,(17.53±3.41)周,t=1.356,P=0.185;(23.58±3.26)周,(25.25±4.19)周,t=1.408,P=0.168]。④综合疗效。术后12个月,联合内固定组优13例、良7例、可2例,微创经皮钢板内固定组优9例、良7例、可1例、差2例; 2组患者综合疗效比较,差异无统计学意义(Z=-0.874,P=0.382)。⑤并发症发生率。联合内固定组患者切口延迟愈合2例、骨折延迟愈合1例,微创经皮钢板内固定组切口感染3例、钢板断裂并骨折不愈合1例、骨折畸形愈合1例。2组患者并发症发生率比较,差异无统计学意义(χ2=0.392,P=0.531)。结论:髓内钉联合辅助钢板内固定治疗难复性胫骨干骨折,与微创经皮钢板内固定治疗比较,能更好地恢复下肢力线、缩短下地行走和完全负重时间、增加膝关节活动度,但二者在手术时间、术中出血量、术后引流量、住院时间、骨折愈合时间、综合疗效及安全性等方面相当。
Abstract:
Objective:To compare the clinical efficacy and safety of intramedullary nail combined with auxiliary plate internal fixation and minimally invasive percutaneous plate internal fixation in the treatment of refractory tibial shaft fractures.Methods:The medical data of 41 patients with refractory tibial shaft fractures were retrospectively analyzed,including 22 cases treated with intramedullary nail combined with auxiliary plate internal fixation(combined internal fixation group)and 19 cases treated with minimally invasive percutaneous plate internal fixation(minimally invasive percutaneous plate internal fixation group).The operation time,intraoperative blood loss,postoperative drainage volume,hospitalization time,tibial coronal plane and sagittal plane angles at one month after operation, bed rest time,full weight-bearing time,clinical fracture healing time,bone healing time,range of motion of knee joint at 12 months after operation,comprehensive curative effect,and incidence of complications were compared between the two groups.Results:①General indicators.There was no significant difference between the two groups in operation time,intraoperative blood loss,postoperative drainage volume,and hospitalization time(75.65±12.51 vs 81.15±14.89 min,t=1.308,P=0.306; 210.54±42.36 vs 220.85±30.56 mL,t=1.216,P=0.233; 120.65±20.73vs 130.34±25.47 mL,t=1.323,P=0.195; 10.28±2.52 vs 9.15±1.46 d,t=1.721,P=0.096).②Evaluation indicators of the mechanical axis of lower limbs.The tibial coronal and sagittal plane angles at one month after operation in the combined internal fixation group were smaller than those in the minimally invasive percutaneous plate internal fixation group(2.28±0.85 vs 3.75±1.92 degrees,t=3.086,P=0.004; 2.45±0.92 vs 3.58±1.76 degrees,t=2.517,P=0.018).③Evaluation indicators of fracture recovery.The bed rest time and full weight-bearing time in the combined internal fixation group were shorter than those in the minimally invasive percutaneous plate internal fixation group(7.23±1.17 vs 8.15±1.58 weeks,t=2.033,P=0.048; 12.54±2.25 vs 14.15±2.74 weeks,t=2.036,P=0.049).The range of motion of the knee joint at 12 months after operation in the combined internal fixation group was greater than that of the minimally invasive percutaneous plate internal fixation group(123.28±10.26 vs 108.98±15.46 degrees,t=-3.432,P=0.002).There was no significant difference between the two groups in clinical fracture healing time and bone healing time(16.25±2.48 vs 17.53±3.41 weeks,t=1.356,P=0.185; 23.58±3.26 vs 25.25±4.19 weeks,t=1.408,P=0.168).④Comprehensive curative effect.At 12 months after operation,13 cases got an excellent result,7 good and 2 fair in the combined internal fixation group; while 9 cases got an excellent result,7 good,1 fair and 2 poor in the minimally invasive percutaneous plate internal fixation group.There was no statistically significant difference between the two groups in comprehensive curative effect(Z=-0.874,P=0.382).⑤Incidence of complications.In the combined internal fixation group,2 cases had delayed incision healing and 1 case had delayed fracture healing.In the minimally invasive percutaneous plate internal fixation group,3 cases had incision infection,1 case had plate fracture and fracture non-healing,and 1 case had fracture malunion.There was no significant difference in the incidence of complications between the two groups(χ2=0.392,P=0.531).Conclusion:Compared with minimally invasive percutaneous plate internal fixation,intramedullary nail combined with auxiliary plate internal fixation in the treatment of refractory tibial shaft fractures can better restore the mechanical axis of lower limbs,shorten bed rest time and full weight-bearing time,and increase the range of motion of the knee joint.However,the two methods are comparable in terms of operation time,intraoperative blood loss,postoperative drainage volume,hospitalization time,fracture healing time,comprehensive curative effect,and safety.

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(收稿日期:2022-10-20 本文编辑:吕宁)

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通讯作者:闫英杰 E-mail:yanyingjie66@163.com
更新日期/Last Update: 1900-01-01