CAJ | 학술논문

背景：胫骨中下段骨折由于无肌肉覆盖，软组织薄，创伤后易发生粉碎的复杂骨折，致术中复位固定较为困难。其临床效果往往和骨折类型、软组织损伤程度、治疗方法及内固定的选择密切相关。胫骨中下段骨折一般以内固定为主，尽管内固定方法很多，但微创的坚强固定一直是胫骨骨折治疗的难点和研究热点。 　　目的：比较经皮闭合复位锁定钢板、经皮闭合复位交锁髓内钉与切开复位钢板置入内固定修复胫骨中下段骨折的临床效果。 　　方法：入选180例胫骨中下段骨折患者，随机分为经皮闭合复位锁定钢板组、经皮闭合复位交锁髓内钉组与切开复位钢板组，分别进行内固定修复治疗。内固定后随访时间为12-24个月。从切口长度、手术时间、术中透视时间、术中出血量、内固定后并发症等方面比较3组的修复效果。 　　结果与结论：剔除失随访患者，经皮闭合复位锁定钢板组56例，经皮闭合复位交锁髓内钉组52例，切开复位钢板组48例进入结果分析。经皮闭合复位锁定钢板组、经皮闭合复位交锁髓内钉组在切口长度、术中出血量等方面明显优于切开复位钢板组(P<0.05)，而透视时间方面经皮闭合复位锁定钢板组显著长于交锁髓内钉和切开复位内固定组(P<0.05)，手术时间方面3组差异无显著性意义。在并发症发生率方面，经皮闭合复位锁定钢板组为11%，经皮闭合复位交锁髓内钉组及切开复位钢板组均为27%。提示对于修复胫骨中下段骨折，闭合复位锁定钢板内固定创伤小，不破坏骨折端血供，具有良好的生物力学稳定性，可以作为胫骨中下段骨折的良好选择；闭合复位交锁髓内钉固定操作简单，也是胫骨中下段骨折的常用方法；切开复位钢板内固定对骨折端剥离较多，血供破坏大，并发症较多，应谨慎选择。揹景：脛骨中下段骨摺由于無肌肉覆蓋，軟組織薄，創傷後易髮生粉碎的複雜骨摺，緻術中複位固定較為睏難。其臨床效果往往和骨摺類型、軟組織損傷程度、治療方法及內固定的選擇密切相關。脛骨中下段骨摺一般以內固定為主，儘管內固定方法很多，但微創的堅彊固定一直是脛骨骨摺治療的難點和研究熱點。 　　目的：比較經皮閉閤複位鎖定鋼闆、經皮閉閤複位交鎖髓內釘與切開複位鋼闆置入內固定脩複脛骨中下段骨摺的臨床效果。 　　方法：入選180例脛骨中下段骨摺患者，隨機分為經皮閉閤複位鎖定鋼闆組、經皮閉閤複位交鎖髓內釘組與切開複位鋼闆組，分彆進行內固定脩複治療。內固定後隨訪時間為12-24箇月。從切口長度、手術時間、術中透視時間、術中齣血量、內固定後併髮癥等方麵比較3組的脩複效果。 　　結果與結論：剔除失隨訪患者，經皮閉閤複位鎖定鋼闆組56例，經皮閉閤複位交鎖髓內釘組52例，切開複位鋼闆組48例進入結果分析。經皮閉閤複位鎖定鋼闆組、經皮閉閤複位交鎖髓內釘組在切口長度、術中齣血量等方麵明顯優于切開複位鋼闆組(P<0.05)，而透視時間方麵經皮閉閤複位鎖定鋼闆組顯著長于交鎖髓內釘和切開複位內固定組(P<0.05)，手術時間方麵3組差異無顯著性意義。在併髮癥髮生率方麵，經皮閉閤複位鎖定鋼闆組為11%，經皮閉閤複位交鎖髓內釘組及切開複位鋼闆組均為27%。提示對于脩複脛骨中下段骨摺，閉閤複位鎖定鋼闆內固定創傷小，不破壞骨摺耑血供，具有良好的生物力學穩定性，可以作為脛骨中下段骨摺的良好選擇；閉閤複位交鎖髓內釘固定操作簡單，也是脛骨中下段骨摺的常用方法；切開複位鋼闆內固定對骨摺耑剝離較多，血供破壞大，併髮癥較多，應謹慎選擇。
배경：경골중하단골절유우무기육복개，연조직박，창상후역발생분쇄적복잡골절，치술중복위고정교위곤난。기림상효과왕왕화골절류형、연조직손상정도、치료방법급내고정적선택밀절상관。경골중하단골절일반이내고정위주，진관내고정방법흔다，단미창적견강고정일직시경골골절치료적난점화연구열점。 　　목적：비교경피폐합복위쇄정강판、경피폐합복위교쇄수내정여절개복위강판치입내고정수복경골중하단골절적림상효과。 　　방법：입선180례경골중하단골절환자，수궤분위경피폐합복위쇄정강판조、경피폐합복위교쇄수내정조여절개복위강판조，분별진행내고정수복치료。내고정후수방시간위12-24개월。종절구장도、수술시간、술중투시시간、술중출혈량、내고정후병발증등방면비교3조적수복효과。 　　결과여결론：척제실수방환자，경피폐합복위쇄정강판조56례，경피폐합복위교쇄수내정조52례，절개복위강판조48례진입결과분석。경피폐합복위쇄정강판조、경피폐합복위교쇄수내정조재절구장도、술중출혈량등방면명현우우절개복위강판조(P<0.05)，이투시시간방면경피폐합복위쇄정강판조현저장우교쇄수내정화절개복위내고정조(P<0.05)，수술시간방면3조차이무현저성의의。재병발증발생솔방면，경피폐합복위쇄정강판조위11%，경피폐합복위교쇄수내정조급절개복위강판조균위27%。제시대우수복경골중하단골절，폐합복위쇄정강판내고정창상소，불파배골절단혈공，구유량호적생물역학은정성，가이작위경골중하단골절적량호선택；폐합복위교쇄수내정고정조작간단，야시경골중하단골절적상용방법；절개복위강판내고정대골절단박리교다，혈공파배대，병발증교다，응근신선택。
BACKGROUND:The distal tibia shaft fracture is prone to be comminuted after trauma due to the absence of muscle covering and the thin soft tissue, and intraoperative reduction and fixation are difficult. Clinical efficacy is closely related to the type of fracture, degree of soft tissue injury, choice of therapy and internal fixation. Internal fixation is the main treatment for the distal tibia shaft fracture, and a microinvasive, strong fixation is the focus of tibial fracture treatment although many methods for internal fixation are present. OBJECTIVE:To explore clinical efficacy of the treatment of distal tibia shaft fracture using percutaneous locking compression plate, interlocking intramedul ary nail and open reduction with internal fixation. METHODS:A total of 180 patients with distal tibia shaft fracture were randomized into three groups, receiving internal fixation treatment using percutaneous locking compression plate, interlocking intramedul ary nail or open reduction. Al patients were fol owed up for 12-24 months. The clinical outcomes of the treated patients in three groups were compared through the observations of incision length, operation time, intraoperative fluoroscopy time, intraoperative blood loss, complications after fixation. RESULTS AND CONCLUSION:After excluding the loss of fol ow-up, 56 cases receiving percutaneous locking compression plate, 52 cases receiving interlocking intramedul ary nail and 48 cases receiving open reduction were involved in the final analysis. The incision length and intraoperative blood loss in the groups of percutaneous locking compression plate and interlocking intramedul ary nail were significantly better than that of open reduction (P<0.05). Intraoperative fluoroscopy time in the group of percutaneous locking compression plate was significantly longer than that in other two groups (P<0.05). The operation time showed no significant differences among three groups. The rate of complications was 11%in the group of percutaneous locking compression plate, and 27%in the groups of interlocking intramedul ary nail and open reduction with internal fixation. Percutaneous locking compression plate is a good choice for the distal tibia shaft fracture due to smal injury, good biomechanical stability, and no influence on blood supply at fracture end;interlocking intramedul ary nail is also a useful technique due to simple operations. Open reduction with internal fixation should be chosen careful y due to great dissection, great influence on blood supply and high complication rate.