锁定钢板与逆行髓内钉固定股骨远端骨折比较

Locking plates versus retrograde intramedullary nailing for distal femoral fractures

摘要:

［目的］比较锁定钢板与逆行髓内钉治疗股骨远端骨折的临床效果。［方法］2018 年 1 月—2019 年 11 月 100 例股骨远端骨折患者纳入本研究，行开放复位内固定术。根据医患沟通结果，50 例采用钢板固定，50 例采用逆行髓内钉固定。比较两组围手术期、随访及影像资料。［结果］ 两组均顺利完成手术，无严重并发症。髓内钉组手术时间、切口长度、术中失血量、术后引流量及住院时间均显著优于钢板组（P<0.05）；但两组间术中透视次数和切口愈合等级的差异均无统计学意义（P> 0.05）。两组患者随访时间均超过 12 个月，髓内钉组下地行走时间、完全负重活动时间均早于钢板组（P<0.05）；术后随时间推移，两组患者 VAS 评分均显著减少 （P<0.05），而膝 ROM 和 HSS 评分均显著增加 （P<0.05）。术后相应时间点，两组间 VAS 评分差异均无统计学意义（P>0.05），但是髓内钉组 ROM 和 HSS 评分均显著优于钢板组（P<0.05）。影像方面，两组骨折复位质量比较差异无统计学意义 （P>0.05）；但髓内钉组影像骨折愈合时间显著早于钢板组 （P<0.05）。［结论］ 与锁定钢板相比， 逆行髓内钉内固定治疗股骨远端骨折具有创伤小，术后功能恢复好的优点。

Abstract:

[Objective] To compare the clinical results of locking plate (LP) versus retrograde intramedullary nailing (RIMN) for distal femur fractures. [Methods] From January 2018 to November 2019, 100 patients with distal femur fractures were enrolled in this study and underwent open reduction and internal fixation. According to preoperative doctor-patient communication results, 50 patients were treated with LP, while the remaining 50 were with RIMN. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All patients in both groups had operation completed successfully without serious complications. The RIMN group proved signifi- cantly superior to the LP group in terms of operation time, incision length, intraoperative blood loss, postoperative drainage volume and hos- pital stay (P＜0.05) . However, there were no significant differences in the number of intraoperative fluoroscopy and wound healing between the two groups (P＞0.05) . All the patients in both groups were followed up for more than 12 months. The RIMN group resumed walking and full weight-bearing activity significantly earlier than the LP group (P＜0.05) . The VAS scores decreased significantly (P＜0.05) , whereas the knee extension-flexion range of motion (ROM) and HSS score increased significantly in both groups over time postoperatively (P＜0.05) . At the corresponding postoperative time point, there was no significant difference in VAS score between the two groups (P＞0.05) , but the RIMN group proved significantly superior to the LP group in terms of ROM and HSS score (P＜0.05) . Radiographically, there was no signifi- cant difference in fracture reduction quality between the two groups (P＜0.05) , however, the RIMN group got fracture healing on images sig- nificantly earlier than the LP group (P＜0.05) . [Conclusion] The retrograde intramedullary nailing for internal fixation of distal femoral frac- tures has advantages of less trauma and better postoperative functional recovery over the locking plate.