Intramedullary nail combined with blocking screws for treating distal tibial fractures

doi:10.3969/j.issn.2095-4344.2016.31.008

Abstract

Abstract:

BACKGROUND: For the treatment of distal tibial fractures, open reduction and plate fixation, minimally invasive percutaneous plate fixation and intramedullary nail fixation are effective, but each has advantages and disadvantages.

OBJECTIVE: To compare the effects of intramedullary nail combined with blocking screws versus minimally invasive percutaneous plate fixation in treating distal tibial fractures.

METHODS: Fifty-one cases of distal tibial fractures were divided into two groups. The blocking screw group (23 cases) was treated with closed reduction and internal fixation with interlocking nail combined with blocking screws. The plate fixation group (28 cases) was treated with minimally invasive percutaneous plate fixation. Fracture healing time, recovery of tibial function and complication occurrence were observed during follow-up.

RESULTS AND CONCLUSION: All patients were followed up for 8 to 32 months. (1) Except one patient in the plate fixation group, the other patients had bony union. The healing time was (4.6±1.7) months in the blocking screw group and (6.9±2.3) months in the plate fixation group. Significant differences in healing time were detected between the two groups (P < 0.05). (2) The excellent and good rate of tibial function recovery was significantly higher in the blocking screw group (100%) than in the plate fixation group (82%) (P < 0.05). (3) No significant difference in the incidence of adverse events was determined between the blocking screw group (13%) and plate fixation group (18%) (P > 0.05). (4) Results suggested that interlocking intramedullary nail combined with blocking screw fixation in the treatment of distal tibial fractures can promote fracture healing and joint function recovery.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Tibial Fractures, Fracture Fixation, Tissue Engineering

CLC Number:

R318

Hou Jing-zhao, Zhang Qiu-lin, Bao Hong-wei, Wu Jin-chun, Tang Hao, Tang Xu-ri. Intramedullary nail combined with blocking screws for treating distal tibial fractures[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(31): 4616-4622.

Figures/Tables 1

2.1 参与者数量分析按意向性分析处理，纳入胫骨远段骨折患者51例，阻挡螺钉组23例，钢板固定组28例，51例患者均获得随访，平均随访时间18(8-32)个月。 2.2 分组流程图见图1。 2.3 两组基线资料比较两组间性别比例、年龄、骨折类型等一般资料比较差异无显著性意义(P > 0.05)，见表1，具有可比性。 2.4 两组预后指标比较阻挡螺钉组骨折愈合时间短于钢板固定组(P < 0.05)，手术时间长于钢板固定组 (P < 0.05)，但总体时间并不长；两组术后恢复时间比较差异无显著性意义(P > 0.05)；阻挡螺钉组在延迟愈合与不愈合并发症发生率为0，钢板固定组1例发生骨折不愈合，说明两种均能取得达到满意的固定效果，见表2。 2.5 两组功能恢复情况比较按照胫骨功能恢复指标Johnner-Wruhs评分，阻挡螺钉组优21例，良2例，可0例，差0例，优良率为100%；钢板固定组优19例，良4例，中3例，差2例，优良率为82%，两组功能情况比较差异有显著性意义(P < 0.05)，见表3。 2.6 不良事件阻挡螺钉组出现1例为外旋8°畸形愈合及1例短缩6 mm畸形愈合，但活动无明显受限和跛行；有1例在打入髓内钉时造成骨折远端经阻挡螺钉处的劈裂，取出阻挡螺钉，在其远端1 cm处重新置入，然后重新打入髓内钉，劈裂的骨折块通过锁定螺钉固定在对侧皮质，最终愈合良好，对功能无任何影响，不良事件发生率13%。钢板固定组中皮肤坏死钢板外露3例，骨不连伴钢板断裂1例，外旋30°畸形愈合1例，不良事件发生率为18%。2组不良事件发生率比较差异无显著性意义(P >0.05)。 2.7 典型病例 47岁男性患者，诊断为右胫骨远段闭合性骨折42-A型，外伤后4 h入院，入院后次日行髓内钉结合阻挡螺钉技术治疗。术中闭合穿钉透视下发现骨折端略向外成角，髓内钉不在远端髓腔中心；退出髓内钉，在骨折远端轴位畸形的凹面钻孔临时插入血管钳，再插入髓内钉见骨折及髓内钉位置明显纠正；将临时安置的血管钳拔出后，改为1枚4.5 mm螺钉作为阻挡钉，再插入髓内钉，术后可见骨折复位很好。手术时间80 min，住院时间11 d，其影像学资料见图2。"

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