单边外固定架与髓内钉固定胫骨螺旋骨折比较△

Unilateral external fixator versus intramedullary nail for fixation of spiral tibial shaft fractures

摘要:

［目的］ 比较单边外固定架与髓内钉治疗胫骨骨折的临床疗效。［方法］ 回顾性分析 2015 年 6 月—2020 年 12 月本院收治的 64 例胫骨螺旋骨折患者资料。根据术前医患沟通结果，32 例采用单边外固定架固定（外固定组），32 例采用髓内钉内固定 （髓内钉组）。比较两组围手术期、随访及影像学资料。［结果］ 64 例患者均顺利完成手术治疗，均无严重并发症。外固定组手术时间、切口长度、术中出血量、下地行走时间和住院时间均显著优于髓内钉组 （P<0.05），两组的术中透视次数均无明显差异 （P>0.05）。64 例患者均获得随访 12 个月以上，外固定组的恢复患肢完全负重活动时间显著早于髓内钉组 （P< 0.05）。随术后时间推移，两组 VAS 评分显著下降（P<0.05），而 AOFAS 评分和踝跖屈-背伸活动度（range of motion, ROM）显著增加 （P<0.05）。相应时间点，两组 AOFAS 评分和 ROM 差异均无统计学意义 （P>0.05）；术后 3 个月外固定组 VAS 评分显著高于髓内钉组（P<0.05），但末次随访两组差异已无统计学意义（P>0.05）。影像学方面，两组骨折复位质量及骨折愈合时间的差异均无统计学意义（P>0.05）。［结论］单边外固定架与髓内钉治疗胫骨螺旋骨折均可获得很好的临床疗效，相比之下，单边外固定架手术创伤更小，允许早期活动。

Abstract:

[Objective] To compare the clinical efficacy of unilateral external fixator versus intramedullary nail for spiral tibial shaft fractures. [Methods] A retrospective study was done on 64 patients who had surgical treatment for spiral tibial shaft fractures in our hospi- tal from June 2015 to December 2020. According to the results of preoperative doctor-patient communication, 32 patients had the fractures fixed with unilateral external fixator (the EF group), while the other 32 patients were fixed with intramedullary nail (the IN group). The peri- operative period, follow-up and imaging data were compared between the two groups. [Results] All the 64 patients were successfully operat- ed on without serious complications. The EF group proved significantly superior to the IN group in terms of operative time, incision length, intraoperative blood loss, postoperative walking time and hospital stay (P＜0.05), despite of no significant difference in the number of intra- operative fluoroscopy between the two groups (P＞0.05). All the 64 patients were followed up for more than 12 months, and the EF group re- sumed full weight-bearing activity of the affected limb significantly earlier than the IN group (P＜0.05). The VAS scores decreased signifi- cantly (P＜0.05), while the AOFAS score and ankle plantar-dorsiflexion range of motion (ROM) increased significantly in both groups over time (P＜0.05). At any corresponding time points there were no significant differences in AOFAS score and ROM between the two groups (P＞ 0.05). The EF group was marked significantly higher VAS score than the IN group 3 months after surgery (P＜0.05), whereas which became not significant different between the two groups at the latest follow-up (P＞0.05). Radiographically, there were no significant differences in the quality of fracture reduction and fracture healing time between the two groups (P＞0.05). [Conclusion] Both unilateral external fixator and intramedullary nail do achieve good clinical outcomes for spiral tibial shaft fractures. In comparison, unilateral external fixator is less invasive and allows patients to actively move early.