Ilizarov外固定架固定与弹性髓内钉治疗儿童胫骨中下段骨折对比分析

摘要

Objective To compare the value of Ilizarov external fixator and elastic intramedullary nail in the treatment of middle and lower tibial fractures in children .Methods Thirty cases of middle and lower tibial fracture treated with elastic intramedullary nail in Taiyuan Maternal and Child Health Hospital from March 2011 to March 2017 were selected as intramedullary nail group .Thirty cases of middle and lower tibial fracture treated with Ilizarov external fixator were selected as external fixator in the same period group .The surgical treatment , excellent and good rate of tibial fracture healing and the incidence of postoperative complications were compared between the two groups .Results The operation time and hospitalization time of the external fixator group were longer than those of the elastic intramedullary nail group , while the loading time , bone healing time and removal time of the fixator were shorter than those of the elastic intramedullary nail group ( P<0.05) .There was no significant difference in the excellent and good rate of fracture healing or the total incidence of complications between the two groups (P>0.05).Conclusions The healing effect and safety of Ilizarov external fixator and elastic intramedullary nail on children's middle and lower tibial fracture are ideal .Although the latter has shorter operation time and less trauma , the former can make the children being able to walk and load as early as possible after surgery , and has shorter bone healing time .Moreover , Ilizarov external fixator is conductive to removal of fixation , so it is better than elastic intramedullary nail treatment to a certain extent .It has unigue advantage , especially for severe communited or open fracture of tibia .The appropriate surgical method should be selected according to the patient's condition and characteristics in clinics .%目的 对比分析Ilizarov外固定架固定与弹性髓内钉治疗儿童胫骨中下段骨折的价值.方法 选择山西省太原市妇幼保健院2011年3月至2017年3月经弹性髓内钉治疗的30例胫骨中下段骨折患儿为髓内钉组,选取同期经Ilizarov外固定架固定治疗的30例胫骨中下段骨折患儿为外固定架组.对比两组手术治疗情况、胫骨骨折愈合优良率及术后并发症发生率.结果 外固定架组手术用时、住院时间均长于弹性髓内钉组,术后下地负重时间、骨性愈合时间、固定物去除时间均短于弹性髓内钉组,差异有统计学意义(P<0.05);两组骨折愈合优良率及术后并发症总发生率比较,差异未见统计学意义(P>0.05).结论 Ilizarov外固定架固定与弹性髓内钉治疗儿童胫骨中下段骨折愈合效果与安全性均理想,后者虽然手术用时更短,微创性更好,但前者可使患儿术后尽早下地负重,骨性愈合时间短,固定物去除更方便,在一定程度上优于弹性髓内钉治疗,尤其是用于严重粉碎性及开放性胫骨骨折的治疗,具有独特优势.临床上应结合患儿病情和特点为其选择合适的术式.