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[1]閆英杰,白丁文,賈剛,等.髓內釘聯(lián)合輔助鋼板內固定和微創(chuàng)經(jīng)皮鋼板內固定治療難復性脛骨干骨折的比較研究[J].中醫(yī)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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髓內釘聯(lián)合輔助鋼板內固定和微創(chuàng)經(jīng)皮鋼板內固定治療難復性脛骨干骨折的比較研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期數(shù):
2023年04期
頁碼:
17-22
欄目:
臨床研究
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:
閆英杰; 白丁文; 賈剛; 楊林
(富平朱老二骨傷醫(yī)院,陜西 富平 711700)
Author(s):
YAN Yingjie; BAI Dingwen; JIA Gang; YANG Lin
Fuping Zhulao'er Orthopaedic Hospital,Fuping 711700,Shaanxi,China
關鍵詞:
脛骨骨折;  骨折固定術; 內;  髓內釘;  骨板;  回顧性研究
Keywords:
tibial fractures;  fracture fixation; internal;  intramedullary nail;  bone plates;  retrospective studies
摘要:
目的:比較髓內釘聯(lián)合輔助鋼板內固定和微創(chuàng)經(jīng)皮鋼板內固定治療難復性脛骨干骨折的臨床療效和安全性。方法:回顧性分析41例難復性脛骨干骨折患者的病例資料,其中采用髓內釘聯(lián)合輔助鋼板內固定治療22例(聯(lián)合內固定組)、采用微創(chuàng)經(jīng)皮鋼板內固定治療19例(微創(chuàng)經(jīng)皮鋼板內固定組)。比較2組患者的手術時間、術中出血量、術后引流量、住院時間、術后1個月脛骨冠狀面和矢狀面成角、下地行走時間、完全負重時間、骨折臨床愈合時間、骨折骨性愈合時間、術后12個月膝關節(jié)活動度和綜合療效及并發(fā)癥發(fā)生情況。結果:①一般指標。2組患者手術時間、術中出血量、術后引流量、住院時間比較,組間差異均無統(tǒng)計學意義[(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下肢力線評價指標。聯(lián)合內固定組患者術后1個月脛骨冠狀面成角和矢狀面成角均小于微創(chuàng)經(jīng)皮鋼板內固定組(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骨折恢復情況評價指標。聯(lián)合內固定組患者下地行走時間、完全負重時間均短于微創(chuàng)經(jīng)皮鋼板內固定組[(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],術后12個月膝關節(jié)活動度大于微創(chuàng)經(jīng)皮鋼板內固定組(123.28°±10.26°,108.98°±15.46°,t=-3.432,P=0.002); 2組患者骨折臨床愈合時間和骨性愈合時間比較,組間差異均無統(tǒng)計學意義[(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綜合療效。術后12個月,聯(lián)合內固定組優(yōu)13例、良7例、可2例,微創(chuàng)經(jīng)皮鋼板內固定組優(yōu)9例、良7例、可1例、差2例; 2組患者綜合療效比較,差異無統(tǒng)計學意義(Z=-0.874,P=0.382)。⑤并發(fā)癥發(fā)生率。聯(lián)合內固定組患者切口延遲愈合2例、骨折延遲愈合1例,微創(chuàng)經(jīng)皮鋼板內固定組切口感染3例、鋼板斷裂并骨折不愈合1例、骨折畸形愈合1例。2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學意義(χ2=0.392,P=0.531)。結論:髓內釘聯(lián)合輔助鋼板內固定治療難復性脛骨干骨折,與微創(chuàng)經(jīng)皮鋼板內固定治療比較,能更好地恢復下肢力線、縮短下地行走和完全負重時間、增加膝關節(jié)活動度,但二者在手術時間、術中出血量、術后引流量、住院時間、骨折愈合時間、綜合療效及安全性等方面相當。
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 本文編輯:呂寧)

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通訊作者:閆英杰 E-mail:[email protected]
更新日期/Last Update: 1900-01-01