阻挡钉技术辅助专家型髓内钉治疗胫骨中下段多段骨折
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摘要
目的探讨阻挡钉技术辅助专家型髓内钉治疗闭合性胫骨中下段多段骨折的临床疗效。方法回顾性分析我院2014年8月至2016年6月收治的15例闭合性胫骨中下段多段骨折病人资料,其中男9例,女6例,年龄为(32.4±5.2)岁(21～48岁);骨折AO分型:42-C1型2例,42-C2型13例。所有病人均采用远端阻挡钉技术辅助专家型髓内钉进行治疗,观察病人术后骨折复位情况、骨折愈合时间、并发症发生率、疼痛视觉模拟量表(visual analogue scale, VAS)评分和Oswestry功能障碍指数(Oswestry disability index, ODI),采用Johner-Wruhs评分对综合疗效进行评定。结果病人均获得随访,随访时间为(25.2±4.3)个月(24～32个月)。13例病人获得骨愈合,愈合时间为(6.8±3.4)个月。2例病人出现骨不连,二期行锁定钢板固定加自体骨植骨后骨折愈合,骨愈合率为86.7%(13/15)。末次随访所有病人在矢状位及冠状位成角均<5°,所有病人均未出现切口感染、断钉及螺钉松动等并发症。术后1.5、3、6个月和末次随访的VAS及ODI评分与术前比较,差异均具有统计学意义(P均<0.05)。综合疗效评定:优9例,良3例,可2例,差1例,优良率为80.0%(12/15)。结论阻挡钉技术配合专家型髓内钉治疗闭合性胫骨中下段多段骨折可纠正骨折端成角,增加内固定的稳定性,并发症发生率低,骨折愈合率高。
Objective To investigate the clinical effectiveness of blocking nail technique and expert intramedullary nail in the treatment of closed multiple fractures of middle and distal tibia. Methods From August 2014 to June 2016, consecutive clinical data of 15 patients with closed multiple fractures of middle and distal tibia were retrospectively analyzed, including 9 males and 6 females with age of(32.4±5.2) years(21-48 years). For AO classification, there were 2 cases of 42-C1 type, and 13 cases of 42-C2 type. All patients were treated with distal blocking nail technique and expert intramedullary nail. Fracture reduction, healing time,complication rate, visual analogue score(VAS) and Oswestry dysfunction index(ODI) were observed. Johnerwruhs score was used to evaluate the curative effectiveness. Results All patients were followed up for(25.2±4.3) months(24-32 months). Bone healing was achieved in 13 patients, with a healing time of(6.8±3.4) months.Bone nonunion occurred in 2 patients, and the fracture healed after locking plate fixation and autogenous bone grafting in the second stage. The healing rate was 87%(13/15). The sagittal and coronal angles were all less than 5 degrees at the last follow-up. No incision infection, screw breakage or screw loosening occurred in all patients. VAS and ODI scores at 1.5, 3, 6 months and last follow-up after operation were significantly different from those before operation(P<0.05). And according to the score, 9 patients were rated as being excellent, 3 good, 2 fair and 1 poor, and the total rate of being excellent to good was 80.0%(12/15). Conclusion The results suggest that blocking nail technique and expert intramedullary nail for closed multiple fractures of middle and distal tibia can correct the angle of fracture, increase the stability of internal fixation, reduce the incidence of complications, and significantly increase the fracture healing rate.
Objective To investigate the clinical effectiveness of blocking nail technique and expert intramedullary nail in the treatment of closed multiple fractures of middle and distal tibia. Methods From August 2014 to June 2016, consecutive clinical data of 15 patients with closed multiple fractures of middle and distal tibia were retrospectively analyzed, including 9 males and 6 females with age of(32.4±5.2) years(21-48 years). For AO classification, there were 2 cases of 42-C1 type, and 13 cases of 42-C2 type. All patients were treated with distal blocking nail technique and expert intramedullary nail. Fracture reduction, healing time,complication rate, visual analogue score(VAS) and Oswestry dysfunction index(ODI) were observed. Johnerwruhs score was used to evaluate the curative effectiveness. Results All patients were followed up for(25.2±4.3) months(24-32 months). Bone healing was achieved in 13 patients, with a healing time of(6.8±3.4) months.Bone nonunion occurred in 2 patients, and the fracture healed after locking plate fixation and autogenous bone grafting in the second stage. The healing rate was 87%(13/15). The sagittal and coronal angles were all less than 5 degrees at the last follow-up. No incision infection, screw breakage or screw loosening occurred in all patients. VAS and ODI scores at 1.5, 3, 6 months and last follow-up after operation were significantly different from those before operation(P<0.05). And according to the score, 9 patients were rated as being excellent, 3 good, 2 fair and 1 poor, and the total rate of being excellent to good was 80.0%(12/15). Conclusion The results suggest that blocking nail technique and expert intramedullary nail for closed multiple fractures of middle and distal tibia can correct the angle of fracture, increase the stability of internal fixation, reduce the incidence of complications, and significantly increase the fracture healing rate.
引文
[1]Bhandari M,Guyatt GH,Tornetta P 3rd,et al.Current practice in the intramedullary nailing of tibial shaft fractures:an international survey[J].J Trauma,2002,53(4):725-732.
[2]胡鹏,陈卫,康两期,等.桥接钢板治疗胫骨干超长节段粉碎性骨折[J].骨科,2015,6(2):79-82.
[3]黄国锋,朱聪,高建廷,等.MIPPO技术与交锁髓内钉内固定治疗胫骨多段骨折的疗效比较[J].中国骨与关节损伤杂志,2018,33(2):185-187.
[4]McMahon SE,Little ZE,Smith TO,et al.The management of segmental tibial shaft fractures:a systematic review[J].Injury,2016,47(3):568-573.
[5]Johner R,Wruhs O.Classification of tibial shaft fractures and correlation with results after rigid internal fixation[J].Clin Orthop Relat Res,1983(178):7-25.
[6]Santolini E,Goumenos SD,Giannoudi M,et al.Femoral and tibial blood supply:a trigger for non-union?[J].Injury,2014,45(11):1665-1673.
[7]Corey RM,Park NK,Cannada LK.Segmental tibia fractures:an analysis of complication and healing rates[J].J Orthop Trauma,2018,32(6):296-300.
[8]Malviya A.Segmental tibial fractures:an assessment of procedures in 27 cases[J].Injury,2004,35(8):834.
[9]梁博伟,赵劲民,殷国前,等.经皮微创钢板固定治疗胫骨下段骨折:与髓内钉固定和切开复位钢板内固定的比较[J].中国组织工程研究,2012,16(17):3116-3120.
[10]Im GI,Tae SK.Distal metaphyseal fractures of tibia:a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation[J].J Trauma,2005,59(5):1219-1223.
[11]Krettek C,Stephan C,Schandelmaier P,et al.The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails[J].J Bone Joint Surg Br,1999,81(6):963-968.
[12]Dogra AS,Ruiz AL,Thompson NS,et al.Dia-metaphyseal distal tibial fractures-treatment with a shortened intramedullary nail:a review of 15 cases[J].Injury,2000,31(10):799-804.
[13]Moongilpatti Sengodan M,Vaidyanathan S,Karunanandaganapathy S,et al.Distal tibial metaphyseal fractures:does blocking screw extend the indication of intramedullary nailing?[J].ISRNOrthop,2014:542623.
[14]陶玉平,王永祥,王静成,等.闭合复位交锁髓内钉固定结合阻挡钉治疗胫骨干骺端骨折[J].中国骨与关节损伤杂志,2013,28(2):170-171.
[2]胡鹏,陈卫,康两期,等.桥接钢板治疗胫骨干超长节段粉碎性骨折[J].骨科,2015,6(2):79-82.
[3]黄国锋,朱聪,高建廷,等.MIPPO技术与交锁髓内钉内固定治疗胫骨多段骨折的疗效比较[J].中国骨与关节损伤杂志,2018,33(2):185-187.
[4]McMahon SE,Little ZE,Smith TO,et al.The management of segmental tibial shaft fractures:a systematic review[J].Injury,2016,47(3):568-573.
[5]Johner R,Wruhs O.Classification of tibial shaft fractures and correlation with results after rigid internal fixation[J].Clin Orthop Relat Res,1983(178):7-25.
[6]Santolini E,Goumenos SD,Giannoudi M,et al.Femoral and tibial blood supply:a trigger for non-union?[J].Injury,2014,45(11):1665-1673.
[7]Corey RM,Park NK,Cannada LK.Segmental tibia fractures:an analysis of complication and healing rates[J].J Orthop Trauma,2018,32(6):296-300.
[8]Malviya A.Segmental tibial fractures:an assessment of procedures in 27 cases[J].Injury,2004,35(8):834.
[9]梁博伟,赵劲民,殷国前,等.经皮微创钢板固定治疗胫骨下段骨折:与髓内钉固定和切开复位钢板内固定的比较[J].中国组织工程研究,2012,16(17):3116-3120.
[10]Im GI,Tae SK.Distal metaphyseal fractures of tibia:a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation[J].J Trauma,2005,59(5):1219-1223.
[11]Krettek C,Stephan C,Schandelmaier P,et al.The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails[J].J Bone Joint Surg Br,1999,81(6):963-968.
[12]Dogra AS,Ruiz AL,Thompson NS,et al.Dia-metaphyseal distal tibial fractures-treatment with a shortened intramedullary nail:a review of 15 cases[J].Injury,2000,31(10):799-804.
[13]Moongilpatti Sengodan M,Vaidyanathan S,Karunanandaganapathy S,et al.Distal tibial metaphyseal fractures:does blocking screw extend the indication of intramedullary nailing?[J].ISRNOrthop,2014:542623.
[14]陶玉平,王永祥,王静成,等.闭合复位交锁髓内钉固定结合阻挡钉治疗胫骨干骺端骨折[J].中国骨与关节损伤杂志,2013,28(2):170-171.