胫骨超远端解剖型髓内钉和胫骨远端内侧锁定加压钢板治疗胫骨下段骨折比较研究.docVIP

胫骨超远端解剖型髓内钉和胫骨远端内侧锁定加压钢板治疗胫骨下段骨折比较研究 　　【摘要】 目的：探讨胫骨超远端解剖型髓内钉与胫骨远端内侧锁定加压板治疗胫骨下段骨折的手术创伤、并发症及手术效果。方法：对46例胫腓骨下段骨折行内固定术，随机数字表法分为两组，A组22例，行闭合复位、胫骨超远端解剖型髓内钉内固定；B组24例，行闭合复位、经皮锁定加压钢板内固定。对两组手术创伤、围手术期并发症和术后功能情况进行比较。结果：所有患者平均随访22.9个月。两组的切口长度、手术时间比较差异有统计学意义（P0.05）。结论：对于胫骨下段骨折，采用闭合复位、胫骨超远端解剖型髓内钉与胫骨远端内侧锁定加压板治疗是有效的可行的，均可以减少手术再创伤，愈合率高，恢复快。 　　【关键词】 胫骨下段骨折； 闭合复位； 内固定； 胫骨超远端解剖型髓内钉； 胫骨远端内侧锁定加压钢板 　　【Abstract】 Objective： To compare the outcome of ultru distal interlocking intramedullary nail and medial distal tibial locking compression plate in the treatment of distal tibial fracture. Method： This study reviewed 56 cases of distal tibial fracture . The patients were divided into two groups， ultru distal interlocking intramedullary nail group（group A） in 27 cases， medial distal tibial locking compression plate group（group B） in 29 cases， according to surgical methods. The clinical data of surgical trauma， complications and postoperative function of the two groups were compared. Result： The patients were followed up for 18-30 months （22.9 months on average）. The length of incision and the mean operation time of the two groups were different significantly（P0.05）. Conclusion： For the distal tibial fracture with closed reduction， ultru distal interlocking intramedullary nail and medial distal tibial locking compression plate can provide a firm fixation and reduce the post-traumatic wounds of the surgery with low complication rate. They are effective and feasible in treatment of the distal tibial fracture. 　　【Key words】 Distal tibial fracture； Closed reduction； Internal fixation； Ultru distal interlocking intramedullary nail； Medial distal tibial locking compression plate 　　First-author’s address： Laiyuan Hospital of Baoding City， Laiyuan 074300， China 　　doi：10.3969/j.issn.1674-4985.2014.22.050 　　胫骨下段骨折后因软组织少，其血运较差，骨折愈合慢，追求骨折解剖复位往往需要切开骨折处，必然加重局部血运的破坏。闭合复位内固定也已达成共识，不切开骨折处，可最大限度保护骨折局部血运，减少医源性干扰。笔者进行了前瞻性研究，自2009年3月-2013年12月对46例胫腓骨下段骨折分别采用胫骨超远端解剖型髓内钉或胫骨远端内侧锁定加压钢板闭合复位治疗，并进行对比分析。 　　1 资料与方法