两种锁定髓内钉固定方案治疗胫骨新鲜闭合性骨折疗效及安全性比较

目的探讨比较交锁与旋入式自锁髓内钉两种固定方案治疗胫骨新鲜闭合性骨折疗效及安全性。方法选取笔者医院2010年10月~2014年10月收治的76例胫骨新鲜闭合性骨折患者,男性44例,女性32例,平均年龄(42.79±5.48)岁,致伤机制包括道路交通伤27例,坠落伤21例,棍棒打击伤19例,跌伤9例。以随机区组法分为A组(38例)和B组(38例),分别给予交锁髓内钉与旋入自锁髓内钉固定方案治疗;比较两组患者围手术期临床指标、切开复位率、二次手术率、术后膝踝关节功能恢复效果及术后并发症发生率等。结果 B组患者围手术期临床指标均显著优于A组,手术时间(53.63±8.72)min vs.(81.45±12.63)min,术中X线照射时间(4.75±1.01)min vs.(22.96±6.43)min,下地活动时间(7.22±2.33)d vs.(14.60±4.71)d,骨折愈合时间(111.57±22.16)d vs.(149.70±35.64)d,P0.05;两组患者切开复位率比较差异无统计学意义(34.21%vs.42.11%,P0.05);B组患者二次手术率显著低于A组(2.63%vs.10.53%,P0.05);B组患者术后膝踝关节恢复效果显著优于A组(89.47%vs.71.05%,P0.05);同时B组患者术后并发症发生率显著低于A组(5.26%vs.21.05%,P0.05)。结论旋入式自锁髓内钉固定方案治疗胫骨新鲜闭合性骨折具有操作简便、术中辐射量小及术后恢复快等优势,可有效提高术后膝踝关节功能,降低二次手术风险,并有助于预防术后并发症发生,疗效及安全性优于交锁髓内钉。

Efficacy and safety of two regimens of locking intramedullary nail fixation in treating closed fresh tibial fracture

Objective To discuss the differences in efficacy and safety of two fixation regimens of interlocking intramedullary nail (IIN) and rotary self-locking intramedullary nail (RSIN) in the treatment of closed fresh tibial frac-ture.Methods From Oct.2010 to Oct.2014, 78 patients with closed fresh tibial fracture admitted and treated in our hospital were selected as research objects and divided into Group A (n=38) and Group B (n=38) using a random num-ber table.Group A was given IIN and Group B was given RSIN for treatment .The perioperative clinical indexes including the rates of open reduction and second operation, postoperative function restoration effects of knee and ankle joints, and incidence rate of postoperative complications were compared between two groups .Results The perioperative clinical indexes in Group B were significantly better than those in Group A (P<0.05).For the rates of open reduction, the difference between two groups was not statistically significant (P>0.05).The rate of second operation in Group B was significantly lower than that in Group A (P<0.05).The postoperative function restoration effect in Group B was significantly better than that in Group A (P<0.05).The incidence rate of postoperative complications in Group B was significantly lower than that in Group A (P<0.05).Conclusion The RSIN fixation regimen in trea-ting closed fresh tibial fracture has the advantages of easy operation , low-dose radiation during the operation and quick recovery .It can improve the postoperative function of knee and ankle joints effectively , reduce the risk of sec-ond operation , and help to prevent postoperative complications .The efficacy and safety of RSIN were better than those of IIN.