目的 比较胫骨逆行髓内钉与胫骨顺行髓内钉治疗胫骨远端关节外骨折患者的临床疗效。方法 回顾性分析2020年8月~2022年8月我科收治的56例胫骨远端关节外骨折患者。23例患者接受胫骨逆行髓内钉固定，33例患者接受胫骨顺行髓内钉固定，记录并比较两组的一般临床资料、手术时间、透视次数、住院时间、骨折愈合时间、完全负重时间、胫骨远端关节面成角、末次随访时美国足踝矫形外科协会 (American Orthopedic Foot and Ankle Society, AOFAS) 评分、并发症等指标。 结果 所有患者均获12~20个月的随访。逆行髓内钉组骨折线距胫骨远端关节面平均距离较顺行髓内钉组更短，差异有统计学意义 (P=0.001)。两组患者的其他一般临床资料差异无统计学意义。顺行髓内钉组平均透视次数多于逆行髓内钉固定组，差异具有统计学意义(P=0.001)；逆行髓内钉组完全负重时间和骨折愈合时间均优于顺行髓内钉组，差异有统计学意义(P=0.002和P=0.018)。逆行髓内钉组和顺行髓内钉组术后并发症分别为4例和10例，并发症发生率差异无统计学意义。 结论 逆行和顺行胫骨髓内钉均是治疗胫骨远端关节外骨折的有效方法，从透视次数、完全负重时间和骨折愈合时间来看，逆行髓内钉更具有优势。
Abstract
Objective To compare the clinical efficacy of retrograde tibial intramedullary nail and antegrade tibial intramedullary nail in the treatment of patients with extra-articular distal tibial fractures. Methods A retrospective review was conducted for 56 patients admitted to our department with extra-articular distal tibial fractures between August 2020 to August 2022. Twenty-three patients were treated with retrograde intramedullary nail fixation and 33 patients were treated with anterograde intramedullary nail fixation. Baseline characteristics, surgical time, fluoroscopy frequency, hospital stay, fracture healing time, complete weight-bearing time, distal tibial articular surface angulation, American Orthopedic Foot and Ankle Society (AOFAS) score at the last follow-up, and other complications were recorded and compared between the two groups. Results All patients were followed up for 12-20 months. In the retrograde intramedullary nail group, the average distance of the fracture line to the distal tibial articular surface was shorter than that of the anterograde intramedullary nail group, and the difference was statistically significant (P=0.001). There was no statistically significant difference in other general clinical data between the two groups of patients. The average number of fluoroscopy times in the anterograde intramedullary nail group was higher than that in the retrograde intramedullary nail group, and the difference was statistically significant (P=0.001). The complete weight-bearing time and fracture healing time of the retrograde intramedullary nail group were better than those of the anterograde intramedullary nail group, and the difference was statistically significant (P=0.002 and P=0.018). There were 4 cases of postoperative complications in the retrograde intramedullary nail group and 10 cases in the anterograde intramedullary nail group, with no statistically significant difference in the incidence of complications. Conclusions Both retrograde and antegrade intramedullary nails are effective methods for treating extra-articular distal tibial fractures. Retrograde intramedullary nails have the advantages of number of intraoperative fluoroscopy, complete weight-bearing time, and fracture healing time.
关键词
胫骨远端骨折； /
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逆行髓内钉； /
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顺行髓内钉； /
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完全负重； /
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骨折愈合； /
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微创治疗
Key words
Extra-articular distal tibial fractures; /
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Retrograde tibial intramedullary nails; /
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Antegrade tibial intramedullary nails; /
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Full weight-bearing; /
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Fracture union; /
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Minimally invasive treatment
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