三种不同内固定方式治疗胫骨中下段A、B型骨折疗效比较

马睿 赵万超 王宏林

摘 要 目的：比较交锁髓内钉、经皮闭合复位锁定钢板、切开复位钢板内固定治疗胫骨中下段骨折的治疗效果。方法：选取胫骨中下段骨折患者180例，根据内固定治疗方式分为交锁髓内钉组60例（A组）、经皮闭合复位锁定钢板组52例（B组）、切开复位钢板组68例（C组）。比较三组患者术相关指标和并发症发生情况及术后6个月JohnerWruhs评分。结果：A组和B组切口长度、骨折愈合时间均少于C组（P<0.05），术后6个月Johner-Wruhs评分高于CC组（P<0.05）；A组开始负重时间最早，B组次之，C组最长（P<0.05）；B组术后并发症发生率低于A组和C组（P<0.05）。结论：与切开复位钢板内固定相比，经皮闭合复位锁定钢板和交锁髓内钉是治疗胫骨中下段骨折具有更好的治疗效果。

关键词 交锁髓内钉 经皮闭合复位锁定钢板 切开复位钢板 内固定 胫骨中下段骨折

中图分类号：R687.3； R683.42 文献标志码：A 文章编号：1006-1533（2021）03-0042-03

Comparison of three different internal fixation methods for the treatment of type A and B fractures of middle and lower tibia

MA Rui， ZHAO Wanchao， WANG Honglin

（Department of Orthopedics， Dagang Hospital of Binhai New Area， Tianjin 300270， China）

ABSTRACT Objective： To compare the therapeutic effects of interlocking intramedullary nail， percutaneous closed reduction and locking plate and open reduction plate in the treatment of middle and lower tibial fractures. Methods： One hundred and eighty cases of middle and lower tibial fractures were divided into an intramedullary interlocking nail group （n=60， group A）， a percutaneous closed reduction and locking plate group （n=52， group B） and an open reduction plate group （n=68， group C） based on the different treatment methods of their internal fixation. The operation-related indexes， the incidence of complications and Johner-Wruhs scores at six months after operation were compared among the three groups. Results： The incision length and fracture healing time were less and Johner-Wruhs scores at six months after operation were higher in group A and B than group C （P<0.05）. The weight-bearing time was the earliest in group A， the second in group B and the longest in group C （P<0.05）. The incidence of postoperative complications was lower in group B than group A and C （P<0.05）. Conclusion： Percutaneous closed reduction and locking plate and interlocking intramedullary nail are more effective than open reduction plate in the treatment of middle and lower tibial fractures.

KEY WORDS interlocking intramedullary nail； percutaneous closed reduction locking plate； open reduction plate； internal fixation； fracture of middle and lower tibia

脛骨中下段骨折为创伤骨科常见疾病，多由高能量损伤所致。由于胫骨解剖结构比较特殊，胫前内侧无肌肉覆盖，中下段周围软组织较少，由肌腱和皮肤包裹，中下1/3处局部血供差，创伤后易发生粉碎的复杂骨折，伴较重的软组织损伤，常合并血管神经损伤，同时可出现旋转、短缩及分离等，致术中复位固定较为困难，骨折后易出现骨折延迟愈合、不愈合、畸形愈合、感染或坏死等并发症[1]。因此，胫骨骨折一直是临床治疗的难点之一。

胫骨中下段骨折一般以内固定为主[2]。目前临床上用于胫骨中下段骨折的内固定方法很多。本文分别应用交锁髓内钉、经皮闭合复位锁定钢板、切开复位钢板治疗胫骨中下段骨折，对三种不同内固定方式的的治疗效果进行比较，现总结如下。

1 资料与方法

1.1 临床资料

选取2015年3月—2019年6月我院收治的胫骨中下段骨折患者180例，根据内固定治疗方式分为三组。……