闭合复位带锁髓内针内固定治疗闭合型胫骨中下段骨折分析

摘要

Objective To compare the advantages and disadvantages of the closed reduction and interloc-king intramedullary needle with traditional open reduction and internal fixation in the treatment of closed tibial frac-tures in the middle and lower segment of tibia.Methods Totally 50 patients with fracture in the middle and lower segments of the tibia ( Type A42-3 and Type b42 1-3) from Jan.2009 to Dec.2012 were selected and randomly di-vided into two groups:the traditional group(25 cases) with open reduction( DCP or LCDCP) plate fixation method, and the comparison group(25 cases) with closed reduction and interlocking intramedullary needle fixation.The fol-low-up period was 16 months.The average hospitalization stay,average hospitalization expenses,postoperative pain, postoperative complications and fracture healing period were compared between the two groups.Results The com-parison group had significant advantages in the treatment cycle,postoperative pain index and treatment costs.As for treatment effect,in the traditional group, 2 cases occurred wound swelling,1 case improved after treatment,1 case of wound infection and bone exposure recovered after local flap repair in the later stage,1 case of delayed fracture heal-ing recovered after a second surgery and bone graft.Wound problem did not occur in the comparison group.Bad fixed position occurred in 1 case and recovered after surgical correction in the comparison group.Complications and fracture healing period in the comparison group were less than those in the traditional group and the results had sta-tistical significance( P<0.05) .Conclusion Closed reduction and intramedullary needle fixation in the treatment of closed fractures in the middle and lower segment of tibial has good clinical effect and relatively low costs.It is worthy for wide application in primary hospitals.%目的：探讨闭合复位带锁髓内针在治疗闭合型胫骨中下段骨折与传统切开复位钢板固定各自的优缺点。方法笔者将2009年1月～2012年12月3年收治的符合胫骨中下段A421～3型及部分B421～3型骨折患者50例，随机分为两组：传统组（25例）采用切开复位（DCP或LCDCP）钢板固定手术方式，比较组（25例）采用闭合复位带锁髓内针固定术式，随访期限为16个月，比较两组平均住院天数、平均住院费用、术后患者疼痛程度、手术平均操作时间、术后并发症发生率及骨性愈合周期。结果闭合复位带锁髓内针固定在治疗周期、术后疼痛指数、治疗费用上明显占优势。治疗效果：传统组2例出现伤口红肿，1例经治疗后好转，1例出现伤口感染、骨外露，后期采取局部皮瓣转移修复后康复，1例骨折延迟愈合，二次手术植骨治疗后康复；比较组未出现伤口问题，1例因内固定位置不良，二次手术矫正后康复，并发症及骨折愈合周期均低于传统组，结果具有统计学意义（ P＜0.05）。结论闭合复位带锁髓内针在治疗闭合型胫骨中下段骨折方面具有良好的临床治疗效果，治疗费用相对较低，适于基层医院广泛应用。