专家型髓内钉内固定与胫骨远端内侧解剖锁定板在微创治疗胫骨中下段骨折中的疗效
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摘要
目的对比研究专家型髓内钉与胫骨远端内侧解剖锁定钢板内固定在微创治疗胫骨中下段骨折中的临床疗效,找出一种治疗胫骨中下段骨折操作简单、效果良好的术式。方法选取我院收治的胫骨中下段骨折患者76例,按随机数字表法分为髓内钉组和锁定钢板组,髓内钉组(n=38例)采取专家型髓内钉内固定治疗,锁定钢板组(n=38例)采取胫骨远端内侧解剖锁定钢板内固定治疗,两组均采用闭合复位微创内固定,所有患者术后获得11～13个月随访(平均11.5个月),比较两组患者的临床疗效。结果两组均用止血带阻断患肢血流,两组手术切口长度、术中出血量、住院时间的差异无统计学意义(P> 0.05),髓内钉组术中C臂透视次数多于锁定钢板组,差异有统计学意义(P <0.05)。髓内钉组手术时间长于锁定钢板组,髓内钉组的术后负重功能锻炼时间、骨折愈合时间均短于锁定钢板组,差异有统计学意义(P <0.05)。结论胫骨远端骨折可选用专家型髓内钉以及锁定钢板治疗,均可获得令人满意的治疗效果,医师可根据患者具体情况选择。
Objective To compared expert-type intramedullary nailing and distal medial tibial anatomical locking plate in minimally invasive treatment of middle and lower tibial fractures, and find a surgery with simple operation and good effect. Methods 76 patients with middle and lower tibia fractures were randomly divided into intramedullary nail group and locking plate group, with 38 patients in each. The intramedullary nail group received treatment of expert intramedullary nailing, while locking plate group got treatment of distal medial tibial anatomical locking plate. Both groups were treated with closed reduction and minimally invasive internal fixation. All patients were followed up for 11 to 13 months(average on 11.5 months) after surgery, and the clinical efficacy of the two groups was compared. Results Tourniquets were used to block the blood flow of the affected limb in both groups, and there were no statistically significant differences in the length of the incision, intraoperative blood loss and length of hospital stay between the two groups(P > 0.05). The operative time of the intramedullary nail group was longer than that of the locking plate group, and the postoperative weight-bearing exercise time and fracture healing time of the intramedullary nail group were shorter than those of the locking plate group, with statistically significant differences(P < 0.05). Conclusion Expert-type intramedullary nail and locking plate can be used to treat distal tibial fracture, and satisfactory therapeutic effects can be achieved.
Objective To compared expert-type intramedullary nailing and distal medial tibial anatomical locking plate in minimally invasive treatment of middle and lower tibial fractures, and find a surgery with simple operation and good effect. Methods 76 patients with middle and lower tibia fractures were randomly divided into intramedullary nail group and locking plate group, with 38 patients in each. The intramedullary nail group received treatment of expert intramedullary nailing, while locking plate group got treatment of distal medial tibial anatomical locking plate. Both groups were treated with closed reduction and minimally invasive internal fixation. All patients were followed up for 11 to 13 months(average on 11.5 months) after surgery, and the clinical efficacy of the two groups was compared. Results Tourniquets were used to block the blood flow of the affected limb in both groups, and there were no statistically significant differences in the length of the incision, intraoperative blood loss and length of hospital stay between the two groups(P > 0.05). The operative time of the intramedullary nail group was longer than that of the locking plate group, and the postoperative weight-bearing exercise time and fracture healing time of the intramedullary nail group were shorter than those of the locking plate group, with statistically significant differences(P < 0.05). Conclusion Expert-type intramedullary nail and locking plate can be used to treat distal tibial fracture, and satisfactory therapeutic effects can be achieved.
引文
[1]李军,詹俊锋,石志刚,等.两种内固定方法治疗胫骨中下段骨折的疗效比较[J].临床骨科杂志,2017,21(4):483-486.
[2]张轩轩.交锁髓内钉技术与微创经皮钢板技术治疗成人胫骨中下段骨折的meta分析[D].广州:南方医科大学,2013.
[3]印卫锋,陈苏,李兴艳,等.专家型髓内钉与锁定钢板内固定治疗胫骨中下段骨折的疗效对比[J].中国骨与关节损伤杂志,2015,30(12):1269-1272.
[4]Sebastian Kuhn,Philipp Appelmann,Philip Pairon,et al.The Retrograde Tibial Nail:Presentation and biomechanical evaluation of a new concept in the treatment of distal tibia fractures[J]. Injury,2014,45(10):S81-S86.
[5]王世坤,史宗新,刘新民,等.髓内钉与锁定钢板内固定治疗胫骨远侧干骺端骨折的比较研究[J].中国骨与关节损伤杂志,2013,28(10):977-978.
[6]游长焕,黄东海.微创经皮钢板与带锁髓内钉治疗胫骨骨折患者的临床疗效[J].医疗装备,2017,31(8):128-129.
[7]庄强,卢水生,严胜军.专家型髓内钉和锁定钢板内固定治疗胫骨下段骨折的效果及安全性对比[J].中国当代医药,2016,9(30):50-52.
[8]TNasir Hayat, Mushtaq Ahmad.The effects of computed tomography scanner parameters on the quality of the reverse triangular surface model of the fibula[J].Journal of the Brazilian Society of Mechanical Sciences and Engineering,2016,38(1):21-31.
[9]刘军强,陆磊,陈新平,等.微创经皮锁定钢板内固定与传统切开复位内固定治疗胫骨骨折的临床研究[J].江西医药,2016,63(2):149-150.
[10]叶茂,郑勇,刘艳西,等.经皮微创锁定加压钢板内固定术治疗胫骨远端骨折疗效观察[J].新乡医学院学报,2015,22(1):68-70.
[11]李鹏,陈伟.胫骨远端内侧锁定加压钢板内固定治疗胫骨远端骨折[J].中国骨与关节损伤杂志,2013,28(6):580-581.
[12]曹丽萍,范宏伟,何艳红.髓内钉与加压钢板治疗胫骨中下段骨折的临床疗效比较[J].实用骨科杂志,2013,20(10):944-945.
[13]韩奎敬,陈鹏涛,周岳来,等.专家型胫骨髓内钉治疗胫骨下段骨折的临床疗效[J].江苏医药,2017,43(23):1736-1738.
[14]沈松坡,强华,赵尔弘.专家型胫骨髓内钉治疗胫骨远端骨折的初期疗效[J].实用骨科杂志,2016,23(3):229-232.
[15]夏建军,彭树进,董长红,等.专家级髓内钉治疗胫骨下1/3骨折临床分析[J].中国骨与关节损伤杂志,2016,31(S1):111-112.
[2]张轩轩.交锁髓内钉技术与微创经皮钢板技术治疗成人胫骨中下段骨折的meta分析[D].广州:南方医科大学,2013.
[3]印卫锋,陈苏,李兴艳,等.专家型髓内钉与锁定钢板内固定治疗胫骨中下段骨折的疗效对比[J].中国骨与关节损伤杂志,2015,30(12):1269-1272.
[4]Sebastian Kuhn,Philipp Appelmann,Philip Pairon,et al.The Retrograde Tibial Nail:Presentation and biomechanical evaluation of a new concept in the treatment of distal tibia fractures[J]. Injury,2014,45(10):S81-S86.
[5]王世坤,史宗新,刘新民,等.髓内钉与锁定钢板内固定治疗胫骨远侧干骺端骨折的比较研究[J].中国骨与关节损伤杂志,2013,28(10):977-978.
[6]游长焕,黄东海.微创经皮钢板与带锁髓内钉治疗胫骨骨折患者的临床疗效[J].医疗装备,2017,31(8):128-129.
[7]庄强,卢水生,严胜军.专家型髓内钉和锁定钢板内固定治疗胫骨下段骨折的效果及安全性对比[J].中国当代医药,2016,9(30):50-52.
[8]TNasir Hayat, Mushtaq Ahmad.The effects of computed tomography scanner parameters on the quality of the reverse triangular surface model of the fibula[J].Journal of the Brazilian Society of Mechanical Sciences and Engineering,2016,38(1):21-31.
[9]刘军强,陆磊,陈新平,等.微创经皮锁定钢板内固定与传统切开复位内固定治疗胫骨骨折的临床研究[J].江西医药,2016,63(2):149-150.
[10]叶茂,郑勇,刘艳西,等.经皮微创锁定加压钢板内固定术治疗胫骨远端骨折疗效观察[J].新乡医学院学报,2015,22(1):68-70.
[11]李鹏,陈伟.胫骨远端内侧锁定加压钢板内固定治疗胫骨远端骨折[J].中国骨与关节损伤杂志,2013,28(6):580-581.
[12]曹丽萍,范宏伟,何艳红.髓内钉与加压钢板治疗胫骨中下段骨折的临床疗效比较[J].实用骨科杂志,2013,20(10):944-945.
[13]韩奎敬,陈鹏涛,周岳来,等.专家型胫骨髓内钉治疗胫骨下段骨折的临床疗效[J].江苏医药,2017,43(23):1736-1738.
[14]沈松坡,强华,赵尔弘.专家型胫骨髓内钉治疗胫骨远端骨折的初期疗效[J].实用骨科杂志,2016,23(3):229-232.
[15]夏建军,彭树进,董长红,等.专家级髓内钉治疗胫骨下1/3骨折临床分析[J].中国骨与关节损伤杂志,2016,31(S1):111-112.