逆行髓内钉与钢板固定胫骨远端关节外骨折比较△（开放获取）

Comparison of retrograd intramedullary nail versus plate fixation for distal tibial extraarticular fractures

摘要:

[目的]比较胫骨逆行髓内钉（retrogradetibialintramedullary nailing, RTIN）与微创经皮钢板接骨（minimally invasive percutaneous plate osteosynthesis, MIPPO）治疗胫骨远端关节外骨折的临床疗效。[方法]回顾性分析 2021 年 6 月—2022 年12 月本院收治的40例胫骨远端关节外骨折患者的临床资料。按照术前医患沟通结果，将患者分为两组，RTIN组18例，MIPPO 组22例。比较两组围手术期、随访与影像资料。[结果]所有患者均顺利完成手术。RTIN组的切口总长度[(6.7±0.5)cmvs (10.4±1.1) cm, P＜0.001] 和住院时间 [(13.9±1.9) d vs (15.6±2.0) d, P=0.012] 显著少于 MIPPO 组；而 RTIN 组术中透视次数显著多于 MIPPO 组[(14.0±2.7) 次 vs (11.6±2.6) 次, P=0.006] 。所有患者均获 12~20 个月随访。RTIN 组完全负重活动时间[(85.9±11.3) d vs (98.6±23.5) d, P=0.042] 显著早于 MIPPO 组，随时间推移，两组VAS评分、AOFAS评分、踝ROM均显著改善（P＜0.05），相应时间点，两组间上述指标的差异均无统计学意义（P＞0.05）。RTIN组软组织激惹显著优于MIPPO组[否/是, (18/0)vs(15/7) ,P= 0.008] 。末次随访时，两组下蹲能力和Johner-Wruh评分的差异均无统计学意义（P＞0.05）。影像方面，与术前相比，末次随访时两组双侧胫骨长度差、胫骨远端外侧角（lateraldistaltibialangle, LDTA)、胫骨远端前侧角（anterior distal tibial angle, ADTA） 均显著减小（P＜0.05）。相应时间点，两组间上述影像指标的差异均无统计学意义（P＞0.05）。所有病例均获得骨性愈合。[结论]两种经皮内固定技术均可有效治疗胫骨远端骨折，逆行髓内钉的临床疗效更佳。

Abstract:

[Objective] To compare the clinical efficacy of retrograde tibial intramedullary nail (RTIN) versus minimally invasive percutaneous plate osteosynthesis (MIPPO) in the treatment of extraarticular fractures of the distal tibia. [Methods] A retrospective research was done on 40 patients who received surgical treatment for distal tibial extraarticular fractures in our hospital from June 2021 to December 2022. According to the preoperative doctor-patient communication, 18 patients received RTIN, while the remaining 22 patients were treated with MIPPO. The perioperative, follow-up and imaging data of the two groups were compared. [Results] All patients were operated on successfully. The RTIN cohort was significantly less than the MIPP cohort in terms of total incision length [(6.7±0.5) cm vs (10.4±1.1) cm, P＜0.001] and hospital stay [(13.9±1.9) days vs (15.6±2.0) days, P=0.012], whereas the former consumed significantly more intraoperative fluoroscopy times than the latter [(14.0±2.7) times vs (11.6±2.6) times, P=0.006]. All patients in both cohorts were followed up from 12 months to 20 months, and the RTIN group regained full weight-bearing activity significantly earlier than the MIPPO group [(85.9±11.3) days vs (98.6±23.5) days, P=0.042]. The VAS and AOFAS scores, as well as ankle flexion-extension ROM in both groups were significantly improved over time (P＜0.05), whereas which were not statistically significant between the two groups at any time points accordingly (P＞ 0.05). The RTIN cohort proved significantly superior to the MIPPO in terms of soft tissue irritation [no/yes, (18/0) vs (15/7), P=0.008], while, the squat capacity and Johner-Wruh scale were not significantly different between the two groups at the last follow-up (P＞0.05). With respect of imaging, the bilateral tibial length discrepancy, lateral distal tibial angle (LDTA) and anterior distal tibial angle (ADTA) were significantly improved in both groups at the latest follow-up compared with those preoperatively (P＜0.05), while which were not significantly different between the two groups at time point accordingly (P＞0.05). All patients in both cohorts had bone healed well at the latest follow-up. [Conclusion] Both percutaneous internal fixation techniques do effectively treat distal tibial extraarticular fractures, in comparison, the retrograde intramedullary nailing achieves better clinical consequence over the minimal invasive percutaneous plate osteosynthesis.