摘要
目的比较髓内钉联合阻挡钉与双钢板内固定治疗胫骨近端关节外骨折的疗效,探讨其适应证范围。方法60例胫骨近端关节外骨折患者,按手术方式分为治疗组(24例)和对照组(36例),分别行髌上入路髓内钉联合阻挡钉内固定和双钢板内固定,比较两组的临床疗效。结果所有患者均顺利完成手术,术后恢复良好。60例患者均获得随访,随访时间6~9个月,平均(7.7±1.1)个月。治疗组术中出血量、手术时间、住院时间、切口总长度及总费用均少于对照组,骨折临床愈合时间及负重时间早于对照组,差异均有统计学意义(P<0.05)。两组术后1周及术后1、3、6个月HSS评分均较术前明显改善(P<0.05),且治疗组术后各时点HSS评分均明显优于对照组(P<0.05)。临床疗效:治疗组优12例,良10例,中2例,优良率91.67%;对照组优20例,良10例,中6例,优良率83.33%。治疗组发生骨折延迟愈合2例(8.33%),对照组并发症6例(16.67%),其中骨折延迟愈合4例,皮肤切口愈合缓慢2例。两组优良率、并发症率比较均无统计学差异(P>0.05)。结论髌上入路髓内钉联合阻挡钉内固定治疗胫骨近端关节外骨折具有复位佳,软组织创伤小,出血少,费用低,愈合快,功能恢复早等优点,对于软组织条件较差,骨折较为稳定,贫血及骨质疏松者尤为适宜。
Objective To compare the effect of intramedullary nail combined with blocking screw and double plate in the internal fixation of extra-articular fracture of proximal tibia,and to explore the scope of its indications.Methods Sixty patients with extra-articular fracture of proximal tibia were divided into the treatment group(24 cases)and the control group(36 cases)according to surgical procedure,and were treated by internal fixation with intramedullary nail combined with blocking screw via suprapatellar approach and double plate,respectively.The clinical effect were compared between the two groups.Results All 60 patients completed the operation successfully and recovered well after the operation during 6 to 9(mean,7.7±1.1)months follow-up.Compare to the control group,the intra-operative blood loss,operation time,hospitalization time,incision length and hospitalization cost were less,and healing time and load time were earlier in the treatment group,and all the differences were significant statistically(P<0.05).The HSS scores were significantly improved at 1 week and 1-,3-and 6 months after the surgery in both groups than those before the surgery(P<0.05),and the HSS scores of the treatment group were significantly better than those of the control group at all time points after the surgery(P<0.05).Post-operative clinical efficacy revealed that 12 cases of excellent,10 cases of good and 2 cases of moderate in the treatment group,and 20 of excellent,10 of good and 6 of moderate in the control group.Delayed union of fractures occurred in 2 cases of the treatment group,and delayed union of fractures in 4 cases and slow-healing of skin incisions were found in 2 cases of the control group.There was no statistical difference in the fineness rate(91.67%vs.83.33%)and complication incidence(8.33%vs.16.67%)between the treatment group and the control groups(P>0.05).Conclusion The internal fixation of intramedullary nails combined with blocking screws with suprapatellar approach is an effective technique with advantages of ideal reduction,minimal soft tissue trauma,less bleeding,low cost,fast healing,early functional recovery and few post-operative complications for extra-articular fracture of proximal tibia,especially suitable for the patients with poor skin-tissue condition,relatively stable fracture ends,anemia and osteoporosis.
作者
徐鹏
王雨辰
黄盛昌
鄂远
张焕
贾川
Xu Peng;Wang Yuchen;Huang Shengchang;E Yuan;Zhang Huan;Jia Chuan(Department of Traumatic Orthopaedics,Traditional Chinese Medicine Hospital of Wujin,Changzhou 213161,Jiangsu,China)
出处
《中国现代手术学杂志》
2023年第1期57-63,共7页
Chinese Journal of Modern Operative Surgery
基金
常州市卫健委科技项目(WZ202019)
常州市武进区科技计划项目(WS202030)
常州市卫生健康青苗人才项目(CZQM2020122)。
关键词
胫骨近端关节外骨折
骨折内固定术
髓内钉
阻挡钉
extra-articular fractures of proximal tibia
fracture fixation,internal
intramedullary nail
blocking screw
