河北医科大学学报 ›› 2020, Vol. 41 ›› Issue (10): 1145-1148,1153.doi: 10.3969/j.issn.1007-3205.2020.10.007

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髓内钉治疗慢性感染性胫骨平台骨折不愈的疗效及其对膝关节功能和炎症反应的影响

  

  1. 上海市第八人民医院骨科，上海 200235
  • 出版日期:2020-10-25 发布日期:2020-10-27
  • 作者简介:戚晓冬（1979-），男，上海人，上海市第八人民医院主治医师，医学学士，从事骨科疾病诊治研究。
  • 基金资助:
    上海市徐汇区卫健委项目“上海市徐汇区尖峰学科”(SHXH201702)；徐汇区科学技术委员会、徐汇区卫生计生委面上项目(SHXH201807)

The effect of intramedullary nail in the treatment of chronic infectious tibial plateau fractures and its influence on knee joint function and inflammation#br#
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  1. Department of Orthopedics, Shanghai Eighth People′s Hospital, Shanghai 200235, China
  • Online:2020-10-25 Published:2020-10-27

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摘要： 目的  比较髓内钉和金属接骨板内固定治疗慢性感染性胫骨平台骨折不愈的疗效及其对膝关节功能和炎症反应的影响。
方法  选择慢性感染性胫骨平台骨折不愈患者90例，根据手术方式不同分为研究组和对照组，每组45例。研究组予以髓内钉治疗，对照组予以金属接骨板内固定。比较2组手术时间、术中出血量、创面愈合时间、住院时间、骨折愈合时间、完全负重时间和并发症发生率。术后1 d和术后3个月比较2组骨痂生长评分、膝关节功能评分、伸膝最大角度和屈膝最大角度，术后1 d和术后2周比较2组血清高敏C反应蛋白（high-sensitivity C-reactive protein，hs-CRP）、白细胞介素6（interleukin-6，IL-6）、白细胞介素8（interleukin-8，IL-8）和肿瘤坏死因子α（tumor necrosis factor-α，TNF-α）水平。
结果  研究组手术时间、术中出血量、创面愈合时间、住院时间、骨折愈合时间和完全负重时间明显短于或少于对照组（P＜0.01）。术后3个月，2组骨痂生长评分、膝关节功能评分、伸膝最大角度和屈膝最大角度均明显高于术后 1 d，研究组骨痂生长评分、膝关节功能评分、伸膝最大角度和屈膝最大角度高于对照组（P＜0.01）。术后2周，2组血清hs-CRP、IL-6、IL-8和TNF-α水平均明显低于术后1 d，研究组血清hs-CRP、IL-6、IL-8和TNF-α水平均低于对照组（P＜0.01）。研究组并发症发生率低于对照组（P＜0.05）。
结论  髓内钉治疗慢性感染性胫骨平台骨折不愈疗效显著、创伤小、血供破坏少，有利于促进术后膝关节功能恢复和控制炎症。


关键词: 胫骨骨折, 骨折, 不愈合, 髓内钉, 感染

Abstract: Objective  To compare the efficacy of intramedullary nail and plate internal fixation in the treatment of chronic infectious tibial plateau fractures, and their effects on knee joint function and inflammation. 
Methods  Ninety patients with chronic infectious tibial plateau fractures were selected and divided into study group and control group according to different surgical methods, with 45 cases in each group. The study group received intramedullary nail treatment, and the control group received steel plate internal fixation. The operation time, intraoperative blood loss, wound healing time, hospitalization time, fracture healing time, full weight bearing time and complication rate were compared between two groups. The callus growth score, knee joint function score, maximum knee extension angle and maximum knee flexion angle were compared between two groups at 1 day and 3 months after surgery. Serum high-sensitivity C-reactive protein(hs-CRP) was compared between two groups at 1 day and 2 weeks after surgery interleukin-6(IL-6), interleukin-8(IL-8) and tumor necrosis factor-α(TNF-α) levels. 
Results  The operation time, intraoperative blood loss, wound healing time, hospitalization time, fracture healing time and full weight bearing time in the study group were significantly less than those in the control group(P＜0.01). At 3 months after surgery, the callus growth score, knee joint function score, maximum knee extension angle, and maximum knee flexion angle in two groups were significantly higher than those at the first day after surgery. The callus growth score, knee joint function score, and knee extension maximum in the study group, the angle and the maximum angle of knee bending were higher than those of the control group(P＜0.01). Two weeks after surgery, the serum levels of hs-CRP, IL-6, IL-8 and TNF-α in two groups were significantly reduced on the first day after surgery. The serum hs-CRP, IL-6, IL-8 and TNF-α in the study group were lower than those in the control group(P＜0.01). The incidence of complications in the study group was lower than that in the control group(P＜0.05). 
Conclusion  Intramedullary nails are more effective in treating chronic infectious tibial plateau fractures, with less trauma and less blood supply damage, which is beneficial to promote postoperative knee function recovery and control inflammation. 


Key words: tibial fractures, fractures, ununited, intramedullary nail, infection

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