髓内钉与经皮锁定钢板对胫骨中下段骨折患者的应用效果对照研究

蔡长马 张磊 吕占辉

摘  要：目的  研究髓内钉与经皮锁定钢板手术应用于胫骨中下段骨折患者中的效果。方法  回顾性分析滨州市中心医院2019年1月～2020年1月确诊的80例胫骨中下段骨折患者资料，按照手术方式的不同设组，对照组（n=40）接受经皮锁定钢板术治疗，研究组（n=40）接受髓内钉手术处理，比较两组围术期相关指标以及随访8个月的踝关节功能。结果  两组手术时间与透视次数对比，无统计学意义（P>0.05）;但研究组其余围术期指标（术中出血量、住院时间及骨性愈合时间）均优于对照组，对比有统计学意义（P<0.05）。术后8个月随访，研究组踝关节功能优良率与对照组相比，差异无统计学意义（P>0.05）。结论  髓内钉用于胫骨中下段骨折患者的处理，对踝关节功能的恢复效果与经皮锁定钢板基本相当，并可减少术中出血，加快术后恢复以及骨性愈合，相对适用于局部软组织条件较差的患者。

关键词：髓内钉;经皮锁定钢板手术;胫骨中下段骨折;效果

中图分类号：R683.42    文献标识码：A    文章编号：1009-8011（2021）-5-0005-03

Abstract： Objective  To study the effect of intramedullary nail and percutaneous locking plate surgery in patients with middle and lower tibial fractures. Methods  The data of 80 patients with middle and lower tibial fractures diagnosed in our hospital from January 2019 to January 2020 were retrospectively analyzed. Set up groups according to different surgical methods. The control group（n=40） received percutaneous locking plate surgery， and the study group（n=40） received intramedullary nail surgery. The two groups were compared with perioperative related indicators and followed up for 8 months Ankle function. Results  The comparison between the operation time and the number of fluoroscopy between the two groups was not statistically significant（P>0.05）; but the remaining perioperative indicators （Intraoperative blood loss， hospital stay and bone healing time） of the study group were better than those of the control group， and the comparison was statistically significant（P<0.05）. After 8 months of follow-up， the excellent and good rate of the study group and the control group were not statistically different（P>0.05）. Conclusion  Intramedullary nails are used for the treatment of patients with middle and lower tibial fractures. The recovery effect of ankle joint function is basically the same as that of percutaneous locking steel plates. It can reduce intraoperative bleeding， accelerate postoperative recovery and bone healing， and is relatively suitable for local soft tissues Patients with poor conditions.

Keywords： intramedullary nail; percutaneous locking plate surgery; middle and lower tibial fractures; effect

由于解剖結构的特殊性以及缺少软组织覆盖，胫骨中下段极易在低能量损伤作用下引起骨折，并继发骨不连、感染以及畸形愈合等各种并发症[1]。目前临床针对胫骨中下段骨折的治疗以手术内固定为主，常见手术方式包括经皮锁定钢板、髓内钉等。其中经皮锁定钢板自1997年引入微创理念改进后，现已被广泛应用于胫骨骨折的治疗;而髓内钉符合生物学固定的原则，并且兼具动态固定、创伤小等特点，近些年在胫骨骨折的应用也取得较好的效果[2]。本研究探讨了该两种术式用于胫骨中下段骨折患者的治疗效果，结果较满意。具体……