髌上髓内钉与经皮钢板固定胫骨远端1/3骨折的比较△（开放获取）

Suprapatellar intramedullary nailing versus percutaneous plate fixation for distal one third tibial fractures

摘要:

[目的] 比较髌上髓内钉与经皮钢板固定胫骨远端 1/3 骨折的临床疗效。[方法] 回顾性分析 2019 年 1 月—2022 年 12 月于本院手术治疗的 78 例胫骨远端 1/3 骨折的患者资料。根据医患沟通结果，38 例采用髌上髓内钉固定 （髓内钉组），40 例采用经皮钢板固定（钢板组）。比较两组围手术期、随访及影像资料。[结果]两组手术时间、切口总长度、术中失血量、腓骨固定及术中透视次数差异均无统计学意义（P＞0.05），髓内钉组在下地行走时间 [d, (2.1±0.9) vs (3.4±1.0), P＜0.001] 、切口愈合等级 [例, 甲/乙/丙, (37/0/1) vs (32/5/3), P=0.020] 和住院时间 [d, (8.9±1.4) vs (9.8±1.9), P=0.019] 均显著优于钢板组。所有患者均获得 12 个月以上的随访，髓内钉组完全负重活动时间显著早于钢板组 [d, (72.2±11.8) vs (87.2±10.8), P＜0.001]。随时间推移，两组患者疼痛 VAS、Lysholm、AOFAS 评分、膝 ROM 和踝 ROM 均显著改善 （P＜0.05）。末次随访时，两组上述指标的差异均无统计学意义（P＞0.05）。影像方面，末次随访时双侧胫骨长度差、胫骨远端外侧角（lateral distal tibial angle, LDTA）差异无统计学意义（P＞0.05），髓内钉组胫骨远端前侧角（anteriof distal tibial angle, ADTA） [°, (79.3±2.7) vs (80.7±2.8), P=0.033] 显著小于钢板组，髓内钉组骨折愈合时间显著早于钢板组（P＜0.05）。[结论]对于胫骨远端 1/3 骨折，髌上髓内钉与经皮钢板均能取得较好疗效，相比较而言，经皮钢板对膝关节没有干扰，而髌上髓内钉组负重时间更早、骨折愈合更快、软组织并发症发生率更低， 临床应根据具体情况选择应用。

Abstract:

[Objective] To compare the clinical efficacy of suprapatellar intramedullary nailing (IMN) versus percutaneous plate (PP) fixation for distal one third tibial fractures. [Methods] A retrospective study was conducted on 78 patients who underwent surgical treatment for distal 1/3 tibial fractures in our hospital from January 2019 to December 2022. According to the doctor-patient communication, 38 patients received IMN, while other 40 patients underwent PP. The perioperative, follow-up and imaging data of the two groups were compared. [Results] Although there were no statistically significant differences in the operation time, total incision length, intraoperative blood loss, fibular fixation and the number of intraoperative fluoroscopy between the two groups (P＞0.05), the IMN group proved significantly superior to the PP group in terms of ambulation time [days, (2.1±0.9) vs (3.4±1.0), P＜0.001], incision healing grade [A/B/C, (37/0/1) vs (32/5/ 3), P=0.020] and hospital stay [days, (8.9±1.4) vs (9.8±1.9), P=0.019]. All patients were followed up for more than 12 months, and the IMN group resumed full weight-bearing activity significantly earlier than the PP group [days, (72.2±11.8) vs (87.2±10.8), P＜0.001]. The pain VAS, Lysholm and AOFAS scores, as well as knee ROM and ankle ROM were significantly improved over time in both groups (P＜0.05). At the last follow-up, there was no statistically significant difference in the above items between the two groups (P＞0.05). As for imaging, there was no statistically significant difference in the leg length discrepency and the lateral distal tibial angle (LDTA) at the last follow-up between the two groups (P＞0.05). The IMN group had significantly smaller anterior distal tibial angle (ADTA) than the PP group [°, (79.3±2.7) vs (80.7±2.8), P=0.033], while the former got fracture healed significantly earlier than the PP group (P＜0.05). [Conclusion] Both suprapatel-lar intramedullary nailing and percutaneous plate do achieve good therapeutic effects for the distal 1/3 fracture of the tibia. By comparison, the percutaneous plates have no interference with the knee, while suprapatellar intramedullary nailing achieves earlier weight-bearing time, faster fracture healing, and a lower incidence of soft tissue complications. Clinically, the two internal fixation techniques should be selected based on specific conditions.