胫骨交锁髓内钉与微创经皮钢板对比治疗胫骨中下段骨折的临床疗效分析

周智勋++滕立初++陈拓++陈涤新++黄屾++温科伟

[摘要] 目的 研究评价胫骨髓内钉治疗胫骨中下段骨折的临床疗效。方法 方便选取2009年2月—2016年5月该院110例胫骨中下段骨折患者进行观察，随机分成A、B两组，分别采用胫骨髓内钉手术治疗及标准微创加压钢板法治疗。于术后对所有患者进行疗效评价，统计两种术式术中出血量、手术时间、住院天数、术后肿胀消退时间等并进行对比。结果 A组优35（63.63%）例，良13（23.63%）例，中7（12.73%）例，差0（0.00%）例，优良率为87.27%，有效率为100.00%。B组优23（41.82%）例，良14（25.45%）例，中12（21.82%）例，差6（10.91%）例，优良率为67.27%，有效率为89.09%。A组有效率及优良率明显高于B组，差异有统计学意义（P<0.05）。A组患者的术中出血量、手术时间、术后肿胀时间均明显少于B组（P<0.05），两组住院天数差异无统计学意义（P>0.05）。结论 胫骨髓内钉治疗胫骨中下段骨折的临床疗效值得肯定，应值得推广。

[关键词] 胫骨髓内钉；脛骨中下段骨折；加压钢板法

[中图分类号] R687 [文献标识码] A [文章编号] 1674-0742（2017）05（b）-0079-03

[Abstract] Objective To research the clinical curative effect of interlocking nail fixation in fractures of tibia and minimally invasive percutaneous plating in treatment of middle and lower tibial fractures. Methods conveniently 110 cases of patients with middle and lower tibial fractures treated in our hospital from February 2009 to May 2016 were selected for observation and randomly divided into two groups， respectively treated with interlocking nail fixation in fractures of tibia and minimally invasive percutaneous plating， and the curative effect of all patients after operation was evaluated and the intraoperative bleeding amount， operation time， length of stay and postoperative swelling time were compared between the two groups. Results In the group A， 35 cases were excellent （63.63%）， 13 cases were good （23.63%）， 7 cases were fair （12.73%） and 0 case was bad（0.00%） and the excellent and good rate was 87.27%， and the effective rate was 100.00%， in the group B， 23 cases were excellent （41.82%）， 14 cases were good （25.45%）， 12 cases were fair （21.82%） and 6 cases were bad （10.91%）， the excellent and good rate was 67.27% and the effective rate was 89.09%， and the effective rate and excellent and good rate in the group A were obviously higher than those in the group B， and the differences were statistically significant（P<0.05）， and the intraoperative bleeding amount， operation time and postoperative swelling time in the group A were obviously fewer than those in the group B（P<0.05）， and there was no obvious difference in the length of stay between the two groups（P>0.05）. Conclusion The clinical curative effect of interlocking nail fixation in fractures of tibia in treatment of middle and lower tibial fractures is positive， which is worth promotion.

[Key words] Interlocking nail fixation in fractures of tibia； Middle and lower tibial fractures； Compression plating

由于胫骨血供的特殊性，胫骨中下段骨折常会出现因血供不足而导致的延迟愈合甚至不愈合，往往需要再次进行手术[1]。钢板固定术会破坏胫骨的血运，术后骨不连及其他并发症的发生率较高。髓内钉固定能够有效地对抗应力，减少手术创伤，保护血供，有着明显的优势[2]。该研究方便选取2009年2月—2016年5月该院110例胫骨中下段骨折患者进行观察，研究评价胫骨髓内钉治疗胫骨中下段骨折的临床疗效，现报道如下。

1 资料与方法

1.1 一般资料

方便选取该院收治的110例胫骨中下段骨折患者进行观察，纳入标准：符合胫骨中下段骨折的诊断，不稳定性骨折或手法复位失败，较严重的开放性骨折，骨折端刺穿皮肤轻度污染的开放性骨折，缝合伤口后，伤口愈合炎症消退消肿后。……