应用弹性髓内钉与钢板治疗儿童胫骨干骨折的临床研究

Clinical comparison of elastic intramedullary nail and steel plate in the treatment of tibial shaft fracture in children

摘要:

目的：对比弹性髓内钉和钢板在儿童胫骨干骨折治疗中的临床效果。方法：选取2017年1月至2021年1月达州市中心医院骨科收治的儿童胫骨干骨折110例，其中弹性髓内钉组58例，钢板组52例，比较2组术中出血量、手术切口总长度、手术时间、住院时间、住院费用、骨折愈合时间、功能恢复评分、并发症等指标。结果：弹性髓内钉组手术切口总长度[（4.1±0.8） cm]、手术时间[（42.0±6.2） min]、住院费用[（1.5±0.7）万元]、骨折愈合时间[（10.6±1.1）周]均低于钢板组[（10.2±1.4） cm、（65.0±7.6） min、（2.1±0.5）万元、（12.4±1.3）周]，功能恢复评分优良率（98.3%）高于钢板组（86.5%），差异有统计学意义（P<0.05）。弹性髓内钉组术中出血量（应用止血带）、住院时间与钢板组比较差异无统计学意义（P >0.05）。在并发症方面，弹性髓内钉组感染率（1.7%）低于钢板组（13.5%）、早期关节僵硬率（15.5%）高于钢板组（3.8%）；在骨折断端对位对线不良、骨折愈合延迟或骨不连、双下肢长度比较方面2组差异无统计学意义（P >0.05）。结论：弹性髓内钉和钢板适应证有差异，在儿童胫骨干骨折内固定选择上，弹性髓内钉更具优势，适合在临床上推广使用。

Abstract:

Objective：To compare the clinical effects of elastic intramedullary nail and steel plate in the treatment of tibial shaft fracture in children. Methods：A total of 110 children with tibial shaft fractures treated in the Department of Orthopaedics of Dazhou Central Hospital from January 2017 to January 2021 were selected，including elastic intramedullary nail group（n=58） and steel plate group（n=52）. The intraoperative blood loss，total incision length，operation time，hospital stay，hospitalization expenses，fracture healing time，functional recovery scores and complications were compared between the two groups. Results：The total incision length[（4.1±0.8） cm]，operation time[（42.0±6.2） min]，hospitalization cost[（15 000±7 000） yuan] and fracture healing time[（10.6±1.1）weeks] in the elastic intramedullary nail group were lower than those in the steel plate group[（10.2±1.4） cm，（65.0±7.6） min，（21 000±5 000） yuan and （12.4±1.3） weeks]. The excellent and good rate of functional recovery in the elastic intramedullary nail group（98.3%） was significantly higher than that in the steel plate group（86.5%）（P<0.05）. There was no significant difference in intraop－erative blood loss（using tourniquet） and hospital stay between the elastic intramedullary nail group and the steel plate group（P >0.05）. In terms of complications，the infection rate in the elastic intramedullary nail group（1.7%） was lower than that in the steel plate group（13.5%），and the joint stiffness rate in the elastic intramedullary nail group（15.5%） was higher than that in the steel plate group（3.8%）. There was no significant difference in fracture alignment，delayed fracture healing or nonunion and unequal length of both lower limbs between the two groups（P >0.05）. Conclusion：The indications of elastic intramedullary nail and steel plate are different. Elastic intramedullary nail has more advantages in the selection of internal fixation of tibial shaft fractures in children，and is suitable for clinical application.