闭合和有限切开复位治疗不同类型胫骨干骨折的疗效分析
A clinical comparative study of tibia fracture treated by intrmedullary nail using limited incision or close reduction

摘要：目的 对比分析闭合复位和有限切开复位髓内钉固定治疗胫骨不同类型骨折的临床疗效。方法 对54例胫骨横形骨折、93例斜型骨折、71例粉碎骨折的患者分别采用闭合和有限切开复位交锁髓内钉固定治疗，对比分析不同类型和不同方法的手术时间、射线使用时间、住院时间、不愈合率、感染率及术后功能恢复情况。结果 手术时间上横形骨折患者切开与闭合复位没有差别，斜形骨折的切开复位时间更短，而粉碎骨折的切开复位时间更长；射线使用时间横形骨折患者闭合与切开复位间没有统计学差异，斜形和粉碎骨折闭合复位均使用更长的放射线时间；粉碎骨折的切开复位延长了住院时间；横形和粉碎骨折闭合与切开复位的不愈合率没有明显统计学差异，斜形骨折闭合复位不愈合率高；不同类型骨折各组间感染率没有差别；各种骨折类型切开复位与闭合复位对术后功能恢复无明显影响。结论 应根据不同的骨折类型选择不同的治疗方式，对于斜形、螺旋骨折和复位困难的粉碎骨折可选用有限切开复位内固定，而横形骨折和多数粉碎骨折尽量选用闭合复位。
ABSTRACT: Objective To discuss the clinical therapeutic effect of tibia fracture treated by intramedullary nail using limited incision or close reduction. Methods We treated 54 tibia transverse fracture cases, 93 oblique fracture cases, 71 fragmental fracture cases by intramedullary nail using open with limited incision or close reduction. We then compared operation time, X-ray time, hospital stay duration, infection rate, nonunion rate, and postoperative function restoration between patients with different fractures. Results There was no different operation time in transverse fracture group, but longer for close reduction in oblique fracture group and for open reduction in fragmental fracture group. X-ray time did not differ for open or close reduction in transverse fracture group. Long X-ray time was used in close reduction in oblique and fragmental fracture groups. There was no significant difference in nonunion rate for open and close reduction in both transverse and fragmental fracture groups. The oblique fracture nonuinon rate was higher in close reduction group than in open reduction group. No difference was found in infection rate or function recovery whether for open or close reduction in all types of fractures. Conclusion Different therapy methods should be determined by different fracture types. Open reduction with minimal incision should be used for oblique fracture cases and fragmental fracture cases with reduction difficulty