三种固定方法治疗胫骨中下段骨折临床研究

目的 :比较微创经皮锁定加压钢板、髓内钉、外固定支架治疗胫骨中下段骨折的疗效差异。方法 :回顾性研究2014年7月1日至2016年4月30日南京中医药大学附属盐城市中医院骨伤科收治的54例胫骨中下段骨折患者。19例行微创经皮锁定加压钢板内固定(钢板组);18例行髓内钉内固定(髓内钉组);17例行外固定支架固定(外固定组)。比较三组患者的一般资料、住院时间、骨折愈合时间、术后3个月与6个月Olerud-Molander评分及术后6个月Johner Wruh胫骨功能,并探索年龄、骨折侧别、骨折类型、愈合时间、软组织损伤分级对胫骨功能恢复的影响。结果:三组患者的年龄、性别、骨折侧别、骨折分型及软组织损伤分级比较,差异无统计学意义(P0.05)。外固定组住院时间为(14.47±3.24)d,明显短于钢板组(22.84±4.39)d及髓内钉组(17.56±4.08)d,差异有统计学意义(P0.01)。髓内钉组骨折愈合时间为(13.83±1.76)周,短于钢板组(19.53±3.42)周及外固定组(18.47±3.45)周,差异有统计学意义(P0.01)。髓内钉组术后3个月Olerud-Molander评分最高,与其他两组比较差异有统计学意义(P0.01)。三组术后6个月Olerud-Molander评分及Johner Wruh胫骨功能比较,差异无统计学意义(P0.05)。胫骨功能的恢复与年龄、侧别、软组织损伤分级无明显相关性,但与骨折类型及骨折愈合时间具有一定相关性,骨折类型越复杂、愈合时间越长,术后6个月胫骨功能的恢复情况越差(P0.05)。结论:微创经皮锁定加压钢板、髓内钉与外固定支架对胫骨中下段骨折均有一定疗效,但采用外固定支架者住院时间较短,采用髓内钉者骨折愈合时间较短。

Clinical Study of Three Methods for Treatment of Middle and Distal Tibial Fractures

Objective:To compare the clinical effect of minimally invasive percutaneous plate,intramedullary nail and external fixator on treating middle and distal tibial fractures. Methods:A retrieval study was carried out among 54 patients with middle and distal tibial fractures in the orthopedics and traumatology department of Yancheng Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,from July 1,2014 to April 30,2016. Nineteen patients were treated with minimally invasive percu taneous plate(plate group). Eighteen patients were treated with intramedullary nail(intramedullary nail group).Seventeen patients were treated with external fixator(external fixator group). The general information,duration of hospital stays,bone union time of the three groups were compared after treatment,the Olerud-Molander scores of the three groups were compared three months and six months after the surgery and the Johner Wruh scores of the three groups were compared after six months. At the same time,the effects of age,injured side,type of fractures,bone union time and classification of soft tissue injuries on the recovery of tibia function were explored. Results:There were no statistically significant differences of age,gender,injured side,type of fractures,and classification of soft tissue injuries in the three groups(P> 0.05). The duration of hospital stays of the external fixator group was(14.47±3.24) days which was shorter than that of the plate group with(22.84±4.39) days and the intramedullary nail group with(17.56±4.08) days,and the differences were statistically significant(P<0.01). The bone union time of the intramedullary nail group was(13.83±1.76) weeks which was shorter than that of the plate group with(19.53±3.42) weeks and the external fixator group with(18.47±3.45) weeks,and the differences were statistically significant(P<0.01). Three months after the treatment,the Olerud-Molander score of the intramedullary nail group was the highest,and compared with those of the other two groups,the differences were statistically significant(P <0.01). There were no significant differences of Olerud-Molander scores and Johner-Wruh scores in the three groups six months after the treatment(P> 0.05). The recovery of tibia function had no relationship with age,injured side and classification of soft tissue injuries,but the type of fractures and bone union time were correlated with the recovery of tibia function. The more complicated the type of fractures is and the longer the bone union time is,the worse the tibial function becomes at 6 months after the treatment(P<0.05). Conclusion:For middle and distal tibial fractures,the minimally invasive percutaneous plate,intramedullary nail and external fixator all have certain curative effect. However,the duration of hospital stays of patients treated with external fixator is shorter and the bone union time of patients treated with intramedullary nail is shorter.