钢板与钉子：对于胫骨极端骨折是否有更有效的植入物？

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-04-21 DOI:10.1016/j.jcot.2025.103025

Abhishek Ganta , Fiona K. Cherry , Nirmal C. Tejwani , Sanjit R. Konda , Kenneth A. Egol

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引用次数: 0

摘要

背景：本研究的目的是确定髓内钉（IMN）和钢板内固定治疗“极端”胫骨干骺端骨折的疗效差异。方法前瞻性收集s545例患者，由两名委员会认证的骨科创伤外科医生进行回顾性分析，以确定胫骨干极端骨折（定义为大多数近端或远端节段累及或可能累及钉锁定螺栓包围的区域）。确认了51例患者。25例采用髓内钉治疗的患者与24例采用钢板和螺钉治疗的患者进行了比较。收集的数据包括患者人口统计、手术细节和结果。采用fisher精确检验、独立T检验和多变量线性回归对队列进行比较。结果患者平均年龄46.73岁。群组间ASA、CCI、年龄、男女组成或BMI均无差异。低与高能损伤机制在队列之间没有差异，但IMN队列的开放性骨折比例更高（p = 0.018）。当控制协变量时，接受IMN的患者被允许更早地在手术端负重。在最近的随访中，踝关节或膝关节的活动范围没有差异。IMN组总并发症发生率较高（p = 0.033）。单变量分析显示IMN与骨不连相关（p = 0.050）。IMN倾向于更需要再次手术（p = 0.086）。结论髓内钉治疗“极端胫骨骨折”的总并发症发生率高于钢板内固定，且有再次手术的趋势。然而，应该注意的是，该队列中开放性骨折的发生率较高。在队列之间，不对齐率、活动范围或愈合时间没有差异。

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Plate vs. Nail: Is there a more effective implant for extreme tibia fractures?

Background

The purpose of this study is to determine differences in outcomes between “extreme” tibial metaphyseal fractures treated with intramedullary nailing (IMN) or plate osteosynthesis.

Methods

545 prospectively collected patients were reviewed by two board-certified orthopedic trauma surgeons to identify extreme tibial shaft fractures (defined as most proximal or distal segments that involved or would have involved the area encompassed by the nail locking bolts). Fifty-one patients were identified. Twenty-five patients treated with an intramedullary nail were compared to 24 patients treated with plate and screws for similar patterns. Data collected included patient demographics, surgical details, and outcomes. Cohorts were compared using fisher's exact test, independent T tests, and multivariable linear regression.

Results

The mean age of all patients was 46.73 years. There were no differences in ASA, CCI, age, male/female composition, or BMI between cohorts. There were no differences in low vs. high-energy mechanism of injury between cohorts, however the IMN cohort had a greater proportion of open fractures (p = 0.018). When controlling for covariates, patients who underwent IMN were allowed earlier weight bearing on the operative extremity. There were no differences in ankle or knee range of motion at latest follow up. There was a greater incidence of total complications among IMN (p = 0.033). Single variable analysis revealed an association between IMN and nonunion (p = 0.050). IMN trended towards greater need for reoperation (p = 0.086).

Conclusion

Intramedullary nailing of “extreme tibia fractures” was associated with higher rates of total complications compared to plate osteosynthesis and trended with greater need for reoperation. However, it should be noted that there was a higher incidence of open fractures in this cohort. There were no differences in the rate of malalignment, range of motion, or time to healing between cohorts.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.