ETN結合阻擋釘和LCP治療脛骨下段骨折的療效對比

黃偉楨

【摘要】 目的：比較專家型脛骨交鎖髓內釘（ETN）結合阻擋釘與經皮脛骨遠端鎖定加壓鋼板（LCP）治療脛骨下段骨折的臨床效果。方法：選取本院2014年3月-2016年1月收治的脛骨下段骨折患者84例，按照隨機數字表法分為ETN組與LCP組，各42例，ETN組采用ETN結合阻擋釘固定，LCP組采用LCP固定，比較兩組手術指標、術后恢復情況及并發癥情況。結果：兩組手術時間、術中出血量及術后腫脹消退時間比較，差異均無統計學意義（P>0.05）；ETN組切口愈合等級、骨折臨床愈合時間、踝關節功能評分均優于LCP組，差異均有統計學意義（P<0.05）；ETN組出現切口感染、骨筋膜室綜合征、骨折延遲愈合或不愈合等并發癥情況均少于LCP組（P<0.05），但ETN組骨折畸形愈合例數多于LCP組（P<0.05），ETN組并發生癥發生率低于LCP組（16.67% vs 35.71%），差異有統計學意義（P<0.05）。結論：ETN結合阻擋釘治療脛骨下段骨折相比于LCP技術骨折愈合時間短，切口愈合好，并發癥少，值得臨床推廣。

【關鍵詞】 專家型脛骨交鎖髓內釘； 阻擋釘； 脛骨遠端鎖定加壓鋼板； 脛骨下段骨折

【Abstract】 Objective：To compare the clinical effect of expert tibial interlocking intramedullary nail（ETN） combined with blocking nail and percutaneous tibial distal locking plate（LCP） in the treatment of lower tibial fracture.Method：84 cases of lower tibial fracture were treated in our hospital from March 2014 to January 2016，according to the random number table method，they were divided into ETN group and LCP group，42 cases in each group.ETN group was treated with ETN combined with blocking nail，LCP group was treated with LCP，and the operation index，postoperative recovery and complication of two groups were compared.Result：The operation time，intraoperative blood loss and postoperative swelling regression time of two groups were compared，the differences were not statistically significant（P>0.05）.The incision healing grade，fracture healing time and ankle function score of ETN group were better than those of LCP group（P<0.05）.The incisional infection，osteofascial compartment syndrome，delayed union or unhealed complications of ETN group were less than those of LCP group（P<0.05），but the number of malunion of fracture of ETN group was more than that of LCP group（P<0.05），the total incidence of fracture of ETN group was better than that of LCP group（16.67% vs 35.71%），the difference was statistically significant（P<0.05）.Conclusion：ETN combined with blocking nail in the treatment of lower tibial fractures is shorter than that of LCP.The incision is healed well，the complication is less，and deserves clinical promotion.

【Key words】 Expert tibial interlocking intramedullary nail； Blocking nail； Tibial tibial locking plate； Lower tibial fracture

First-authors address：Puning Peoples Hospital，Puning 515300，China

doi：10.3969/j.issn.1674-4985.2017.29.033

脛骨位于體表，屬于負重骨，容易受到直接暴力的損傷，據統計，脛腓骨骨折占全身骨折的6.8%[1]。由于脛骨下1/3處幾乎無肌肉附著，且周圍軟組織覆蓋薄弱，血供差，骨折后易出現皮膚感染、壞死，骨折延遲愈合或不愈合情況；同時對于需切開復位患者，術中不可避免的造成軟組織損傷或骨膜剝離過多，導致術后并發癥的增加。臨床上對于需切開復位內固定的患者在選擇內固定方式上存在較大爭議，治療難度大[2-3]。目前治療上對于脛骨下段骨折內固定的方式主要有脛骨遠端鎖定加壓鋼板（LCP）結合微創經皮鋼板內固定（MIPO）術與專家型脛骨交鎖髓內釘（ETN）術[4]，前者可保護骨折斷端的血供，為臨床常用的術式，但越來越多的研究表明，LCP技術對于骨折端軟組織存活情況要求較高，對于軟組織較少的骨折，即便術中操作仔細，但仍不可避免的出現皮膚壞死、切口感染、鋼板外露等并發癥[5-6]；后者……