交锁髓内钉与锁定加压钢板治疗胫骨下段骨折的疗效比较

发布时间：2019-01-08 11:58

【摘要】：目的:胫骨下段骨折是临床上较常见的骨折之一,多由高能量损伤所致。由于胫骨下段骨性解剖结构特殊、软组织覆盖较少及血运较差,骨折后易导致骨折延迟愈合、不愈合的发生[1]。因此在治疗胫骨下段骨折的过程中,有效的保护骨折断端血运、减少对软组织及骨外膜的损伤是提高临床治疗效果的关键。交锁髓内钉固定和锁定加压钢板固定是目前胫骨下段骨折较为常用的两种手术内固定方式,但其优劣尚存争议。本课题的研究目的是比较交锁髓内钉与锁定加压钢板治疗胫骨下段骨折的临床疗效,为以后手术方式的选择提供依据。方法:回顾性分析2013年5月至2015年11月我院收治的94例胫骨下段骨折患者为研究对象。男55例,女39例。年龄在21~64岁之间,平均年龄为(40.9±3.1)岁。骨折按照AO分型:A型骨折38例,B型27例,C型29例。合并有腓骨骨折31例;将所有患者随机分为A、B两组,A组共51例行交锁髓内钉内固定术,B组共43例行锁定加压钢板内固定术。两组患者在年龄、性别、骨折分型、合并伤等一般资料方面相比差异无统计学意义(P0.05,Table 1),具有可比性。比较观察两组患者的术中及术后疗效。手术中由同一组人员记录切口长度、手术时间、术中出血量术中等相关数据,随访严格记录患者骨折的愈合时间及患肢术后效果。术后康复训练由我院康复科同一组康复技师进行指导。术后第1天开始卧床行膝、踝关节功能练习,隔日换药,预防感染,术后2周拆除缝线;同时出院后积极鼓励患者进行膝关节、踝关节功能锻炼,此时禁止负重;视骨折愈合情况术后第6-10周才开始部分负重,待骨折愈合后,才能完全负重。所有患者术后均获得18~24个月随访。组间比较术后4周,8周,12周,半年,1年,2年患的骨折愈合程度及并发症的发生情况。术中及术后随访所得数据用SPSS19.0软件进行统计学分析比较,P0.05认为差异具有统计学意义。结果:所有患者术后均进行18~24个月时间随访,平均21.3个月,经随访所得结果显示。两组患者组间相比较,A、B组在手术时间和手术治疗效果两方面,差异无统计学意义(P0.05,Table 2);A组(髓内钉组)患者术中出血量、骨折愈合时间均低于B组(锁定加压钢板组),差异有统计学意义(P0.05,Table 2)。结论:通过本研究可得出,锁定加压钢板内固定术为传统治疗胫骨下段骨折的手术方式,其操作简单,固定效果好,但此方法为切开复位,术中需将骨折端充分暴露,对骨折处周围软组织损伤较大,破坏了血运,容易导致局部皮肤坏死、患肢功能障碍。与钢板组相比,髓内钉组的术后效果更令人满意,髓内固定可有效减轻对骨外膜及软组织的损伤,最大程度的减小手术切口及减少术中出血量,降低其术后并发症的发生率,缩短其骨折愈合的时间。
[Abstract]:Objective: the distal tibia fracture is one of the most common fractures, mostly caused by high energy injury. Because of the special bone anatomical structure of the lower tibia, less soft tissue covering and poor blood circulation, the fracture is prone to delayed union and nonunion. Therefore, in the treatment of distal tibial fractures, the key to improve the clinical treatment is to effectively protect the blood flow at the broken end of the fracture and reduce the injury to the soft tissue and the epineurium. Interlocking intramedullary nail fixation and locking compression plate fixation are two common internal fixation methods for distal tibial fractures, but their merits and demerits remain controversial. The purpose of this study was to compare the clinical efficacy of interlocking intramedullary nail and locking compression plate in the treatment of distal tibial fractures. Methods: from May 2013 to November 2015, 94 patients with distal tibial fractures were retrospectively analyzed. There were 55 males and 39 females. The average age was (40.9 卤3.1) years. According to AO classification, 38 cases were type A fractures, 27 cases were type B fractures and 29 cases were type C fractures. 31 patients with fibula fracture were randomly divided into group A (51 cases) and group B (43 cases). There was no significant difference in age, sex, fracture classification and combined injury between the two groups (P 0.05 Table 1). The results of intraoperative and postoperative treatment were compared between the two groups. The length of incision, the time of operation and the amount of blood lost during the operation were recorded by the same group. The time of fracture healing and the postoperative effect of the affected limb were recorded strictly after follow up. Postoperative rehabilitation training was directed by the same group of rehabilitation technicians in our hospital. On the first day after operation, the patients were kept in bed, ankle function was practiced, dressing was changed every other day, infection was prevented, suture was removed 2 weeks after operation, patients were encouraged to exercise knee joint and ankle joint function after discharge from hospital, and weight-bearing was prohibited. Partial weight loading was only started 6-10 weeks after fracture healing, and full weight loading was achieved after fracture healing. All patients were followed up from 18 to 24 months after operation. The degree of fracture healing and the incidence of complications were compared between groups at 4 weeks, 8 weeks, 12 weeks, 6 months, 1 year and 2 years after operation. SPSS19.0 software was used to analyze and compare the data of intraoperative and postoperative follow-up. P0.05 showed that the difference was statistically significant. Results: all patients were followed up for 18 ~ 24 months (mean 21.3 months). There was no significant difference between the two groups in the time of operation and the effect of operation (P0.05Table 2). In group A (intramedullary nail group), the amount of intraoperative bleeding and the time of fracture healing were lower than those in group B (locking compression plate group), and the difference was statistically significant (P0.05 table 2). Conclusion: this study shows that locking compression plate internal fixation is a traditional operative method for the treatment of distal tibial fractures. The operation is simple and the fixation effect is good, but this method is open reduction, and the fracture ends should be fully exposed during the operation. The soft tissue around the fracture is damaged, which leads to local skin necrosis and limb dysfunction. Compared with the plate group, the intramedullary nail group had more satisfactory postoperative results. Intramedullary fixation could effectively reduce the injury to the periosteum and soft tissue, minimize the operative incision and decrease the amount of intraoperative bleeding, and reduce the incidence of postoperative complications. Shorten the time of fracture healing.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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