钢板与髓内钉内固定治疗胫骨远端骨折的疗效比较

目的探讨钢板内固定与髓内钉内固定治疗胫骨远端AO-A型骨折的疗效。方法79例患者根据内固定方式分为钢板组(采用锁定解剖钢板内固定,45例)和髓内钉组(采用髓内钉内固定,34例)。比较手术时间、术中出血量、骨折愈合时间、并发症、末次随访时踝关节活动度及Lowa评分。结果患者均获得随访,时间12~28周。手术时间、术中出血量、骨折愈合时间、末次随访时踝关节活动度及Lowa评分髓内钉组均优于钢板组,差异均有统计学意义(P<0.01)。并发症发生例数两组比较差异无统计学意义(P>0.05)。结论钢板内固定与髓内钉内固定治疗胫骨远端AO-A型骨折均有效。髓内钉在AO-A型骨折的治疗中有一定的优势,但需要严格掌握手术适应证。

Comparison of the curative effect of using internal fixation with plate and intramedullary nail in the treatment of distal tibial fracture

Objective To evaluate the effect of using locking anatomic plate and intramedullary nail for treatment of type AO-A fracture of distal tibia.Methods According to the internal fixation method,the 79 patients were divided into the plate group(45 patients with locking anatomic plate internal fixation)and the intramedullary nail group(34 patients with intramedullary nail internal fixation).The operative time,intraoperative blood loss,fracture healing time,complications,ankle range of motion and Lowa score at the last follow-up were compared between the two groups.Results The 79 cases were all followed up for 12~28 weeks.Operative time,intraoperative blood loss,fracture healing time,ankle mobility and Lowa score at the last follow-up were all better in the intramedullary nail group than in the plate group,with statistically significant differences(P<0.01).There was no statistically significant difference in the number of cases of complications between the two groups(P>0.05).Conclusions Both locking anatomic plate and intramedullary nail are effective methods in the treatment of type AO-A distal tibial fractures.Intramedullary nailing has some advantages in the treatment of type AO-A distal tibial fracture,but the indications of operation should be strictly controlled.