【摘要】 目的：比较泰勒外固定器与髓内钉治疗胫骨中下段骨折的临床效果。方法：回顾性分析天津市天津医院2016年8月至2019年12月收治的79例胫骨中下段骨折患者的临床资料，其中采用泰勒外固定器行外固定治疗的患者作为外固定组（41例），采用髓内钉行内固定治疗的患者作为髓内钉组（38例）。比较两组患者的手术指标和骨折愈合时间。术后6周、3个月、6个月、1年随访时，观察骨折愈合情况、膝关节（屈曲）活动度及踝关节（背伸+跖屈）活动度、膝关节及踝关节疼痛情况、患肢功能恢复情况，以及术后1年时两组患者并发症发生情况。结果：外固定组患者手术时间和骨折愈合时间短于髓内钉组，术中出血量少于髓内钉组，差异均有统计学意义（P均<0.05）。两组患者住院时间比较，差异无统计学意义（P>0.05）。术后6周，外固定组患者膝关节活动度大于髓内钉组，差异有统计学意义（P<0.05）；术后3个月、6个月、1年，两组患者膝关节活动度比较，差异均无统计学意义（P均>0.05）。术后6周、3个月、6个月，外固定组患者踝关节活动度均小于髓内钉组，差异均有统计学意义（P均<0.05）；术后1年，两组患者踝关节活动度比较，差异无统计学意义（P>0.05）。术后6周、3个月、6个月、1年，外固定组患者膝关节VAS评分中位数均低于髓内钉组，差异均有统计学意义（P均<0.05）；两组患者踝关节VAS评分比较，差异均无统计学意义（P均>0.05）。术后3个月、6个月，外固定组患者AOFAS评分低于髓内钉组，差异均有统计学意义（P均<0.05）；术后6周、1年，两组患者AOFAS评分比较，差异均无统计学意义（P均>0.05）。术后1年，两组患者AOFAS评分优良率比较，差异无统计学意义（P>0.05）。术后6个月，外固定组患者满意度低于髓内钉组，差异有统计学意义（P<0.05）；术后6周、3个月、1年，两组患者满意度比较，差异均无统计学意义（P均>0.05）。两组患者并发症总发生率比较，差异无统计学意义（P>0.05）。结论：应用泰勒外固定器和髓内钉治疗胫骨中下段骨折，均能取得较为理想的临床效果。相比之下，采用泰勒外固定器治疗的手术时间短、术中出血量少、骨折愈合快、术后膝关节疼痛轻，治疗胫骨中下段骨折效果更佳。更多还原

【Abstract】 Objective: To compare the clinical outcomes of Taylor spatial frame and intramedullary nailing in the treatment of middle and lower tibial fractures. Methods: A retrospective analysis was conducted on the clinical data of 79 patients with middle and lower tibial fractures treated at Tianjin Hospital from August 2016 to December 2019. Patients were divided into two groups: 41 treated with Taylor spatial frame(external fixation group) and 38 treated with intramedullary nailing(intramedullary nailing group). The operative indicators and fracture healing time were compared between the two groups. Clinical outcomes, including fracture healing, range of motion of knee and ankle joints, pain scores in the knee and ankle joint, and functional recovery of the affected limb were assessed at 6weeks, 3 months, 6 months and 1 year postoperatively, and incidence of complications was assessed at 1 year postoperatively. Results:Compared with the intramedullary nailing group, the external fixation group had significantly shorter operative time, faster fracture healing, and less intraoperative blood loss(all P<0.05). There was no statistically significant difference in hospital stay between the two groups(P>0.05). At 6 weeks post-surgery, the external fixation group showed superior knee joint range of motion compared to the intramedullary nailing group(P<0.05), with no significant differences observed at 3 months, 6 months, and 1 year post-surgery(all P>0.05).The external fixator group had a significantly lower ankle joint range of motion at 6 weeks, 3 months, and 6 months postoperatively compared to the intramedullary nail group(all P<0.05), but not at 1 year postoperatively(P>0.05). The median VAS scores for the knee joint were significantly lower in the external fixator group at all follow-up points(all P<0.05), while there were no statistically significant differences in the VAS scores for the ankle joint(all P>0.05). AOFAS scores for the affected limb were lower in the external fixator group than in the intramedullary nail group at 3 months and 6 months postoperatively(all P<0.05), with no significant differences at 6 weeks and 1 year post-surgery between the two groups(all P>0.05). The excellent rates of the AOFAS scores were similar between the groups at 1 year postoperatively(all P>0.05). At 6 months post-surgery, the satisfaction rate was significantly lower in the external fixation group than in the intramedullary nail group(P<0.05), with no statistically significant differences at 6 weeks, 3 months or 1 year postoperatively(all P>0.05). The overall complication rate was similar between the groups(P>0.05). Conclusions: Both Taylor spatial frame and intramedullary nailing can achieve excellent clinical outcomes in the treatment of middle and lower tibial fractures. However,the Taylor spatial frame has advantages such as a shorter operative time, less intraoperative blood loss, faster fracture healing, and reduced postoperative knee joint pain, making it a preferable treatment option for middle and lower tibia fractures.更多还原