胫骨骨折髓内钉内固定患者术后早期与晚期负重的对比研究

目的 对比分析胫骨骨折患者髓内钉内固定术后早期负重与晚期负重的临床疗效。方法 回顾性研究。纳入2017年1月—2020年12月蚌埠医学院第一附属医院骨科胫骨骨折患者107例,其中男75例、女32例,年龄18~77（39.9±10.9）岁,均接受髓内钉内固定术治疗。按照术后患肢负重开始时间的不同将患者分为2组：术后4周内患肢开始负重者25例为早期负重组,术后4周内患肢完全不负重者82例为晚期负重组。对比2组患者基线资料、手术时间、置入髓内钉的直径、术后植入材料的失败率、术后3个月膝关节功能Lysholm评分、术后6个月和1年的骨折愈合情况。结果 2组患者的年龄、体质量指数（BMI）、胫骨骨折部位、骨折AO分型及Gustilo分型、美国麻醉医师协会（ASA）分级、损伤机制、是否开放性骨折、有无腓骨骨折、有无外固定架等一般资料比较,以及手术时间和髓内钉直径比较,差异均无统计学意义（P值均>0.05）。早期负重组与晚期负重组患者术后植入材料失败率分别为0和1.21％（1/82）,术后6个月延迟愈合率分别为16.0％（4/25）和29.3％（24/82）,术后1年骨不连分别为4.0％（1/25）和11.0％（9/82）,差异均无统计学意义（P值均>0.05）。早期负重组患者术后3个月膝关节功能评分（88.0±2.4）分,高于晚期负重组的（74.5±4.6）分,差异有统计学意义（t=19.32, P<0.001）。结论 与晚期负重相比,胫骨骨折患者髓内钉内固定术后早期（≤4周）负重能够提升患肢膝关节功能,临床疗效较好,建议临床推广。

Comparative study of early versus delayed postoperative weight-bearing after intramedullary nail fixation of tibia fracture

Objective This study was performed to investigate the clinical effect of intramedullary nail in the treatment of early and late postoperative weight-bearing patients with tibial fractures. Methods Retrospective analysis included 107 patients with tibial fractures from the Department of Orthopedics of the First Affiliated Hospital of Bengbu Medical College from January 2017 to December 2020. The cohort included 75 males and 32 females, aged 18-77 (39.9±10.9) years. All patients were treated with intramedullary nail fixation and divided into two groups according to the starting time of the weight-bearing of the affected limb after operation. The early weight-bearing group had partial-weightbearing of the affected limb within 4 weeks after operation, and the late negative recombination group had no weight-bearing of affected limb within 4 weeks after operation. Baseline data, operation time, diameter of the intramedullary nail, failure rate of implant materials, Lysholm score of knee joint function at 3 months after operation, and fracture healing at 6 months and 1 year after operation were compared. Results No statistical difference was found between the two groups in the general data, such as age, body mass index, tibial fracture location, classification, anesthesia grade, injury mechanism, whether open or fibular fracture, and external fixator (all P values >0.05). No significant difference was found between the two groups in the perioperative indicators, such as operation time and diameter of intramedullary nail (all P values >0.05). No implant failure occurred in the early weight-bearing group compared with one implant failure (1.21%, 1/82) in the no-weight-bearing group. Delayed bone union at six months occurred in 4 (16.0%, 4/25) patients in the early weight-bearing group against 24 (29.3%, 24/82) patients in the no-weight-bearing group. Delayed bone union at one year occurred in one (4.0%, 1/25) patient in the early weight-bearing group against 9 (11.0%, 9/82) patients in the no-weight-bearing group. These results had no significant differences (all P values >0.05). The knee joint function score (88.0±2.4) of the early weight-bearing group was higher than that of the late weight-bearing group (74.5±4.6), with statistically significant difference (t=19.32, P<0.001). Conclusion Early weight-bearing within 4 weeks after intramedullary nail fixation of the tibia fracture can improve the joint function of the affected limb. This phenomenon has a good clinical effect and is worthy of further promotion.