【摘要】 目的对比分析髓内钉附加小钢板技术或阻挡钉技术治疗胫骨近端干性骨折的治疗效果以及相关因素。方法对2013年1月至2018年1月两院收治的36例胫骨近端干性骨折患者的临床资料进行对比,使用传统入路髓内钉附加小钢板固定者19例(A组):男13例,女6例;平均年龄(34.1±15.3)(18～72)岁;致伤因素:交通伤13例,高处坠落伤6例;骨折分型:AO41-A2型10例,AO41-A3型9例。使用阻挡钉技术治疗17例(B组):男9例,女8例;平均年龄(36.9±12.8)(19～55)岁;致伤因素:交通伤15例,高处坠落伤2例;骨折分型:AO41-A2型14例,AO41-A3型3例。比较两组平均住院时间、手术时间、术中透视次数、感染率、骨折愈合时间、膝关节活动范围、术后断端成角度数。结果本组术后获12～24个月(平均15.6个月)随访。两组在感染率、骨折愈合时间、膝关节活动范围方面比较差异均无统计学意义(P>0.05)。在平均住院时间(P=0.047)、手术时间(P<0.001)、术中透视次数(P<0.001)、术后断端成角畸形度数冠状面(P=0.009)及矢状面(P<0.001)相比,差异有统计学意义。结论对胫骨近端干性骨折无论采用传统入路髓内钉附加小钢板或阻挡钉技术治疗均能达到骨折愈合的目的,两者在治疗效果上均可达到满意的疗效。髓内钉附加小钢板整体手术时间、术中透视次数、术后断端成角畸形度数较低,但平均手术耗材费用高、住院时间较长;而髓内钉结合阻挡钉技术则技术要求较高,在手术时间、术中透视次数、术后断端成角畸形方面不如髓内钉附加小钢板技术,在平均手术耗材费用、住院时间方面具有优势。更多还原

【Abstract】 Objective To study the effect of intramedullary nailing with plate or blocking screw in the treatment of proximal tibia extra-articular fracture.Methods Clinical data of 36 cases with proximal tibial fracture were compared from January 2013 to January 2018.All were divided into 2 groups.Group A (intramedullary nailing with plate):n=19;13 males and 6 females;the average age (34.1±15.3) years (range:18-72 years);traffic accident in 13 cases,high fall injury in 6 cases;AO41-A2 10 cases,AO41-A3 9 cases.Group B (intramedullary nailing with blocking screw):n=17;9 males and 8 females;the average age (36.9±12.8) years (range:19-55 years);traffic accident in 15 cases,high fall injury in 2 cases;AO41-A2 14 cases,AO41-A3 3 cases.The average hospital stay,operation time,intraoperative fluoroscopy,infection rate,fracture healing,knee range of motion,and postoperative broken-end angulation were compared between the two groups.Results All patients were followed up for 12-24 months (mean:15.6 months) after operation.No significant differences in infection rate,fracture healing time,and knee range of motion were noted between the two groups (P > 0.05).Significant differences were observed in the average hospital stay (P=0.047),operation time (P < 0.001),intraoperative fluoroscopy (P < 0.001),coronal (P=0.009) and sagittal (P < 0.001) deformity angles of the postoperative broken-end angulation.Conclusions Both implants have shown promising results in proximal tibial extra-articular fractures.Intramedullary nailing with plate needs shorter operation time and less intraoperative fluoroscopy with lower degree of angular deformity,but higher average cost and hospital stay.更多还原