摘要
目的比较探讨环形外固定架与髓内钉治疗胫骨节段性骨折的临床疗效。方法采用回顾性病例对照研究分析2006年1月至2012年12月天津医院收治的43例胫骨节段性骨折患者临床资料,其中男31例,女12例;年龄20~62岁[(35.9±9.6)岁]。AO-OTA分型均为42 C2型。21例采用环形外固定架固定治疗(环形支架组),22例采用髓内钉固定治疗(髓内钉组)。比较两组血管神经损伤情况、骨折复位方式、术后完全负重时间、骨折愈合时间、伤口感染情况,比较两组末次随访时胫骨近端内侧角及后侧角、爱荷华(IOWA)膝关节评分、踝关节IOWA评分、膝关节屈曲活动度、踝关节背伸及跖屈活动度。结果患者均获随访12~48个月[(19.6±2.1)个月]。两组均未发生血管神经损伤等严重并发症。环形支架组21例全部闭合复位骨折,髓内钉组3例行切开复位。环形支架组和髓内钉组术后完全负重时间分别为(12.9±2.8)d和(75.1±8.0)d(P<0.05),骨折愈合时间分别为(7.0±1.0)个月和(8.2±1.4)个月(P<0.05)。两组均未发生深部感染。末次随访时,环形支架组和髓内钉组胫骨近端内侧角分别为(86.7±1.5)°和(93.5±1.7)°(P<0.05),胫骨近端后侧角分别为(82.1±1.8)°和(75.1±2.7)°(P<0.05)。环形支架组膝关节IOWA评分、踝关节IOWA评分、膝关节屈曲活动度及踝关节跖屈活动度与髓内钉组比较,差异均无统计学意义(P>0.05);而髓内钉组踝关节背伸活动度为(30.9±3.0)°,优于环形支架组的(21.2±2.2)°(P<0.05)。结论与髓内钉比较,环形外固定架治疗胫骨节段性骨折具有完全闭合复位、完全负重时间早、骨折愈合快、力线恢复好等优点。
Objective To compare the clinical effect of circular external fixator and intramedullary nail in treatment of tiliial segmental fractures.Methods A retrospective case control study was performed on clinical data of 43 patients with segmental tibial fractures treated from January 2006 to December 2012 in Tianjin Hospital.There were 31 males and 12 females with age range of 20-60 years[(35.9±9.6)years].All fractures were classified as type 42C2 using the AO/OTA classification.A total of 21 patients treated with circular external fixator(circular fixator group)and 22 patients were treated with intramedullary nail(intramedullary nail group).The condition of vascular and neural injuries,methods of fracture reduction,time of full weight bearing,bone healing time and infection rate were compared between the two groups.The proximal tibial medial angle,proximal tibial posterior angle,IOWA knee and ankle joint score,range of motion of flexion of keen joint and range of motion of plantar flexion and dorsal flexion of ankle joint were compared between the two groups at the last follow-up.Results All patients were followed up for 12-48 months[(19.6±2.1)months].There were no vascular and neural injuries or other severe complications in both groups.All 21 patients in circular fixator group underwent closed reduction but 3 patients in intramellary nail group were treated by open reduction.The time of full weight bearing was(12.9±2.8)days and in circular fixator group and(75.1±8.0)days in intramedullary nail group(P<0.05),with bone healing time for(7.0±1.0)months and(8.2±1.4)months,respectively(P〈O.05).There was no deep infection in both groups.In circular fixator group and intramedullary nail group,the proximal tihial medial angle was(86.7±1.5)°and(93.5±1.7)°(P<0.05),while the proximal tibial posterior angle was(82.1±1.8)°and(75.1±2.7)°(P<0.05).No significant differences were found between the two groups at the last follow-up concerning IOWA knee and joint score,range of motion of flexion of keen joint and range of motion of plantar flexion of ankle joint(P>0.05).The range of motion of dorsal flexion of ankle joint in intramedullary nail group was(30.9±3.0)°,better than(21.2±2.2)°in circular fixator group(P〈O.05).Conclusion For segmental tibial fractures,cirlular external fixation is superior to intromedullary nail in aspects of completely close reduction,early full weight bearing and early bone healing anti alignment.
作者
贾鹏
王宏川
石博文
舒衡生
Jia Peng;Wang Hongchuan;Shi Bowen;Shu Hengsheng(Department of Orthopedic Traumatology,Tianjin Hospital,Tianjin 300211,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2021年第9期818-824,共7页
Chinese Journal of Trauma
关键词
胫骨骨折
外固器
骨折固定术
髓内
Tibial fractures
External fixators
Fracture fixation,intramedullary
作者简介
通信作者:舒衡生,Email:drhsshu@hotmail.com,电话:022-60910242。
