闭合复位交锁髓内钉内固定治疗胫骨中下段骨折效果

徐名洪; 李景光; 黄爱民; 傅智平; 杨学明

doi:10.13898/j.cnki.issn.1000-2200.2022.04.020

闭合复位交锁髓内钉内固定治疗胫骨中下段骨折效果

Clinical value of the closed reduction interlocking intramedullary nail for internal fixation in the treatment of middle and lower tibial fractures

摘要

摘要:
目的探讨闭合复位交锁髓内钉内固定(IMN)治疗胫骨中下段骨折效果及对病人功能改善、炎症应激、血清碱性磷酸酶(ALP)、骨钙素N端中分子片段(N-MID)、Ⅰ型胶原羧基末端肽片段(β-CTX)表达的影响。
方法选取胫骨中下段骨折病人80例，按随机数字表分为IMN组和对照组，各40例。对照组行切开复位有限接触钢板内固定，IMN组行IMN。对比2组手术情况，并发症，术后6个月踝关节、膝关节功能恢复优良率，以及术前、术后1 d、术后3 d血清炎症反应指标肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、白细胞介素-6(IL-6)，应激反应指标去甲肾上腺素(NE)、血管紧张素-Ⅱ(Ang-Ⅱ)、皮质醇(Cor)，术前、术后1周及1个月ALP、N-MID、β-CTX水平。
结果IMN组切口长度、术后下地时间、骨折愈合时间均短于对照组，术中出血量、术后引流量、术后24 h患侧小腿中段周径/术前周径比值低于对照组(P < 0.01)；IMN组并发症发生率5.00%，均低于对照组的22.50%(P < 0.05)；2组术后1 d、3 d血清TNF-α、IL-8、IL-6、NE、Ang-Ⅱ、Cor水平均较术前增高，但IMN组低于对照组(P < 0.01)；2组术后1周、1个月ALP、N-MID水平均较术前增高，且IMN组高于对照组，β-CTX水平较术前降低，且IMN组低于对照组(P < 0.01)；IMN组术后6个月踝关节、膝关节功能恢复优良率分别为94.87%、97.44%高于对照组的74.36%、79.49%(P < 0.05)。
结论应用IMN治疗胫骨中下段骨折具有出血少、术后恢复快、并发症少、功能恢复良好等优势，且机体炎症应激反应轻，ALP、N-MID、β-CTX等骨代谢指标恢复快。

Abstract:
ObjectiveTo investigate the clinical value of closed reduction interlocking intramedullary nails for internal fixation(IMN) in the treatment of the middle and lower tibial fractures, and its effects on the improvement of patient function, inflammatory stress, serum alkaline phosphatase(ALP), osteocalcin N-terminal middle molecule fragment(N-MID), type Ⅰ collagen carboxy-terminal peptide fragment(β-CTX) expression.
MethodsEighty patients with middle and lower tibial fractures were divided into the IMN group(n=40) and control group(n=40) according to the random number table.The control group was treated with open reduction and limited-access steel plate internal fixation, and the IMN group was treated with IMN.The operative conditions, complications, excellent and good rates of ankle joint and knee joint function recovery after 6 months of surgery, serum inflammatory response indexestumor necrosis factor-α(TNF-α), interleukin-8(IL-8) and interleukin-6(IL-6) before surgery, after 1 d and 3 d of surgery, stress response indicatorsnorepinephrine(NE), angiotensin-Ⅱ(Ang-Ⅱ) and cortisol(Cor), and levels of ALP, N-MID and β-CTX before, after 1 week and 1 month of opertaion were compared between two groups.
ResultsThe incision length, postoperative time to ground and fracture healing time in IMN group were shorter than those in control group, and the intraoperative blood loss, postoperative drainage and ratio of midsection diameter of the affected side after 24 h of operation to preoperative diameter in IMN group were lower than those in control group(P < 0.01).The incidence rate of complication in IMN group was 5.00%, which was lower than that in control group(22.50%)(P < 0.05).The serum levels of TNF-α, IL-8, IL-6, NE, Ang-Ⅱ and Cor in two groups after 1 day and 3 days of surgery increased compared with before operation, and which in IMN group were lower than those in control group(P < 0.01).After 1 week and 1 month of surgery, the levels of ALP and N-MID in two groups increased compared with before surgery, and the levels of ALP and N-MID in IMN group were higher than those in control group(P < 0.01).After 1 week and 1 month of surgery, the levels of β-CTX in two groups decreased compared with before surgery, and the level of β-CTX in IMN group was lower than that in control group(P < 0.01).The excellent and good recovery rates of ankle joint and knee joint in IMN group afetr 6 months of operation were 94.87% and 97.44%, respectively, which were higher than those in control group(74.36% and 79.49%)(P < 0.05).
ConclusionsThe application of IMN in the treatment of middle and lower tibia fractures has the advantages of less bleeding, rapid postoperative recovery, fewer complications, good functional recovery, light body's inflammatory stress response and fast recovery of the levels of ALP, N-MID, β-CTX.

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