单臂外固定架与髓内钉固定胫骨干骨折比较△

Comparison of unilateral external fixator versus intramedullary nail for fixation of tibial shaft fracture

摘要:

［目的］ 比较单臂外固定架结合拉力钉与髓内钉固定胫骨干骨折的临床疗效。［方法］ 回顾性分析 2016 年 1 月— 2019 年 1 月在本科接受手术治疗的 59 例胫骨骨折患者的临床资料。依据术前医患沟通结果，31 例采用有限切开复位单臂外固定架结合拉力钉固定，28 例采用闭合复位髓内钉固定。比较两组围手术期、随访与影像学资料。［结果］所有患者均顺利完成手术，无严重并发症。外固定组手术时间、切口总长度、术中失血量、术中透视次数、住院时间均显著优于髓内钉组 （P< 0.05）。随访时间平均 （23.32±5.22） 个月，随术后时间推移，两组膝伸-屈 ROM、踝背伸-跖屈 ROM 均显著增加 （P<0.05）， 术后 1、3 个月外固定组膝伸-屈 ROM 显著优于髓内钉组 （P<0.05）。末次随访时，两组 Johner-Wruhs 评分、有无跛行及分度、有无下蹲受限及程度的差异均无统计学意义 （P>0.05）。影像方面，相应时间点，外固定组的对位对线均显著优于髓内钉组（P<0.05）；外固定组的胫骨长度差均显著小于髓内钉组（P<0.05），两组骨折愈合时间的差异有统计学意义（P<0.05）。［结论］有限切开复位单臂外固定架结合拉力钉治疗胫骨干骨折，可获得与髓内钉相当的临床效果，具有操作简单，手术时间短， 术中出血量少，术中透视次数少，骨折愈合快等优点。

Abstract:

[Objective] To compare the clinical outcomes of open reduction and lag screw fixation through limited incision combined with unilateral external fixator (EF) versus closed reduction and intramedullary nail (IN) for tibial shaft fracture. [Methods] A retrospective study was done on 59 patients who received surgical treatment for tibial shaft fractures from January 2016 to January 2019. According to the preoperative doctor-patient communication, 31 patients underwent EF, while the other 28 patients had IN performed. The periopera- tive, follow-up and imaging documents were compared between the two groups. [Results] All patients had the operation completed success- fully without serious complications. The EF group proved significantly superior to the IN group in terms of operation time, total incision length, intraoperative blood loss, intraoperative fluoroscopy times and hospital stay (P＜0.05) . With time of the follow-up lasted for (23.32± 5.22) months on an average, the knee extension-flexion range of motion (ROM) and ankle dorsal extension-plantar flexion ROM significant- ly increased in both groups (P＜0.05) , of which the knee extension-flexion ROM in the EF group was significantly better than that in the IN group at 1 and 3 months after operation (P＜0.05) . At the latest follow-up, there were no significant differences in Johner-Wruhs grade, ex- tents of claudication and squat restriction between the two groups (P＞0.05) . Radiographically, the EF group was significantly superior to the IN group in terms of alignment of the affected tibia at all corresponding time points postoperatively (P＜0.05) , discrepancy of tibial length (P＜0.05) , and the fracture healing time (P＜0.05) . [Conclusion] This limited open reduction and combined fixation with lag screw and unilateral external frame has the advantages of simple operation, short operation time, less intraoperative bleeding, less intraoperative fluoroscopy times, and faster fracture healing, and achieve comparable clinical consequences to the intramedullary nail for tibial shaft frac- tures.