逆行与顺行胫骨髓内钉治疗胫骨远端关节外骨折的疗效对比研究

doi:10.13418/j.issn.1001-165x.2025.1.13

摘要/Abstract

摘要： 目的比较胫骨逆行髓内钉与胫骨顺行髓内钉治疗胫骨远端关节外骨折患者的临床疗效。方法回顾性分析2020年8月~2022年8月我科收治的56例胫骨远端关节外骨折患者。23例患者接受胫骨逆行髓内钉固定，33例患者接受胫骨顺行髓内钉固定，记录并比较两组的一般临床资料、手术时间、透视次数、住院时间、骨折愈合时间、完全负重时间、胫骨远端关节面成角、末次随访时美国足踝矫形外科协会 (American Orthopedic Foot and Ankle Society, AOFAS) 评分、并发症等指标。结果所有患者均获12~20个月的随访。逆行髓内钉组骨折线距胫骨远端关节面平均距离较顺行髓内钉组更短，差异有统计学意义 (P=0.001)。两组患者的其他一般临床资料差异无统计学意义。顺行髓内钉组平均透视次数多于逆行髓内钉固定组，差异具有统计学意义(P=0.001)；逆行髓内钉组完全负重时间和骨折愈合时间均优于顺行髓内钉组，差异有统计学意义(P=0.002和P=0.018)。逆行髓内钉组和顺行髓内钉组术后并发症分别为4例和10例，并发症发生率差异无统计学意义。结论逆行和顺行胫骨髓内钉均是治疗胫骨远端关节外骨折的有效方法，从透视次数、完全负重时间和骨折愈合时间来看，逆行髓内钉更具有优势。

关键词: 胫骨远端骨折； , , 逆行髓内钉； , , 顺行髓内钉； , , 完全负重； , , 骨折愈合； , , 微创治疗

Abstract: Objective To compare the clinical efficacy of retrograde tibial intramedullary nail and antegrade tibial intramedullary nail in the treatment of patients with extra-articular distal tibial fractures. Methods A retrospective review was conducted for 56 patients admitted to our department with extra-articular distal tibial fractures between August 2020 to August 2022. Twenty-three patients were treated with retrograde intramedullary nail fixation and 33 patients were treated with anterograde intramedullary nail fixation. Baseline characteristics, surgical time, fluoroscopy frequency, hospital stay, fracture healing time, complete weight-bearing time, distal tibial articular surface angulation, American Orthopedic Foot and Ankle Society (AOFAS) score at the last follow-up, and other complications were recorded and compared between the two groups. Results All patients were followed up for 12-20 months. In the retrograde intramedullary nail group, the average distance of the fracture line to the distal tibial articular surface was shorter than that of the anterograde intramedullary nail group, and the difference was statistically significant (P=0.001). There was no statistically significant difference in other general clinical data between the two groups of patients. The average number of fluoroscopy times in the anterograde intramedullary nail group was higher than that in the retrograde intramedullary nail group, and the difference was statistically significant (P=0.001). The complete weight-bearing time and fracture healing time of the retrograde intramedullary nail group were better than those of the anterograde intramedullary nail group, and the difference was statistically significant (P=0.002 and P=0.018). There were 4 cases of postoperative complications in the retrograde intramedullary nail group and 10 cases in the anterograde intramedullary nail group, with no statistically significant difference in the incidence of complications. Conclusions Both retrograde and antegrade intramedullary nails are effective methods for treating extra-articular distal tibial fractures. Retrograde intramedullary nails have the advantages of number of intraoperative fluoroscopy, complete weight-bearing time, and fracture healing time.

Key words: Extra-articular distal tibial fractures; , , Retrograde tibial intramedullary nails; , , Antegrade tibial intramedullary nails; , , Full weight-bearing; , , Fracture union; , , Minimally invasive treatment

中图分类号:

R683.42

许遵营, 刘晖, 徐维臻, 张金辉, 熊远飞, 庄平, 林金河, 吴进. 逆行与顺行胫骨髓内钉治疗胫骨远端关节外骨折的疗效对比研究[J]. 中国临床解剖学杂志, 2025, 43(1): 82-89.

Xu Zunying, Liu Hui, Xu Weizhen, Zhang Jinhui, Xiong Yuanfei, Zhuang Ping, Lin Jinhe, Wu Jin. Comparative study on the efficacy of retrograde and anterograde tibial intramedullary nails in the treatment of distal tibial extra-articular fractures[J]. Chinese Journal of Clinical Anatomy, 2025, 43(1): 82-89.

参考文献

[1] 熊远飞, 刘晖, 许遵营, 等. 胫骨逆行髓内钉在高危人群胫骨远端关节外骨折中的应用研究 [J]. 骨科, 2024, 15(1): 71-75. DOI：10.3969/j.issn.1674⁃8573.2024.01.014.
[2] 何敏, 李正茂, 谭文甫, 等. 新型逆行胫骨髓内钉治疗胫骨远端骨折的初步疗效分析 [J]. 中华创伤骨科杂志, 2022, 24(4): 334-338. DOI:10.3760/cma.j.cn115530-20211014-00444.
[3] LIU XK, XU WN, XUE QY, et al. Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: A Systematic Review and Meta-Analysis [J]. Orthop Surg, 2019, 11(6): 954-965. DOI:10.1111/os.12575.
[4] 任磊, 扈克治, 陈惠, 等. 不同内固定方式在胫骨远端骨折中的疗效比较 [J]. 创伤外科杂志, 2023, 25(12): 909-915. DOI:10.3969/j.issn．1009-4237.2023.12.006.
[5] Kuhn S, Appelmann P, Pairon P, et al. The Retrograde Tibial Nail: presentation and biomechanical evaluation of a new concept in the treatment of distal tibia fractures[J]. Injury, 2014, 45 Suppl 1: S81-S86. DOI: 10.1016/j.injury.2013.10.025.
[6] 王义昌, 林文杰, 林涛, 等. 胫骨远端骨折三种内固定方式的有限元分析 [J]. 中国组织工程研究, 2023, 27(36): 5760-5765. DOI:10.12307/2023.721.
[7] Kariya A, Jain P, Patond K, et al. Outcome and complications of distal tibia fractures treated with intramedullary nails versus minimally invasive plate osteosynthesis and the role of fibula fixation [J]. Eur J Orthop Surg Traumatol, 2020, 30(8): 1487-1498. DOI:10.1007/s00590-020-02726-y.
[8] 梁力, 闫文荷, 林世磅. 新型逆行髓内钉治疗胫骨远端骨折的临床疗效 [J]. 中国伤残医学, 2023, 31(2):33-36.DOI: 10.13214/j cnki.cjotadm. 2023.02.008.
[9] 胡廷建. 髓内钉与传统钢板螺丝内固定治疗胫骨远端骨折的疗效研究 [J]. 中国现代药物应用, 2019, 13(24): 39-41. DOI:10.14164/j.cnki.cn11-5581/r.2019.24.017.
[10]李波, 赖培丰, 郭福溪, 等. 对比分析L型钢板与传统锁定钢板内固定术治疗胫骨远端骨折患者的效果 [J]. 现代诊断与治疗, 2022, 33(8): 1190-1193.DOI:1190-3.1001-8174(2022)08-1190-03.
[11]高峰, 王秀会, 夏胜利, 等. 髌上入路与髌下入路胫骨髓内钉治疗胫骨远端骨折的比较 [J]. 生物骨科材料与临床研究, 2024, 21(2): 53-56. DOI：10.3969/j.issn.1672-5972.2024.02.011.
[12] 喻景奕, 周公社, 位新维, 等. 阻挡钉快速置入技术在闭合复位交锁髓内钉内固定治疗胫骨远侧干骺端骨折中的应用[J]. 中华创伤骨科杂志, 2019, 21(2):127-132. DOI：10.3760/cma.j.issn.1671-7600. 2019. 02. 006.
[13]Graulich T, Gerhardy J, Omar Pacha T, et al. Patella baja after intramedullary nailing of tibial fractures, using an infrapatellar/transtendinous approach, predicts worse patient reported outcome[J]. Eur J Trauma Emerg Surg, 2022, 48(5):3669-3675. DOI: 10.1007/s00068-021-01807-9.
[14]He M, Jiang Z, Tan W, et al. Ideal entry point and direction of retrograde intramedullary nailing of the tibia[J]. J Orthop Surg Res,2023,18(1): 472. DOI:10.1186/s13018-023-03921-3.

[1]	李海艳, 黎萌, 杜心如. 股骨头颈压力骨小梁与股骨颈后内侧骨皮质及股骨距移行处的形态学观察及临床意义[J]. 中国临床解剖学杂志, 2025, 43(1): 1-8.
[2]	安雷雷, 孔祥玉, 刘鹏飞, 张宾, 马真, 杜心如. 椎动脉V₃段与第2颈神经毗邻关系的解剖学观测及其临床意义[J]. 中国临床解剖学杂志, 2025, 43(1): 9-13.
[3]	尹都, 岑波, 陈阳, 戴黎明, 周军格, 胡飞. 扩大经鼻入路内镜下斜坡区解剖学研究[J]. 中国临床解剖学杂志, 2025, 43(1): 14-17.
[4]	张凤珍, 尹兆正, 伊钰营, 李磊, 赵婧, 王星, 李琨, 李志军, 张少杰. 基于儿童连续薄层解剖数据集三维重建骶椎及其软骨的可视化研究[J]. 中国临床解剖学杂志, 2025, 43(1): 18-25.
[5]	谢思远, 林源洵, 张沄奡龙, 冯梓誉, 李义凯. 颈椎未成熟骺环的影像学观察[J]. 中国临床解剖学杂志, 2025, 43(1): 26-30.
[6]	王娟, 郭龙军, 滕佳岐, 陈玉昆, 贺文. 双肺下叶静脉解剖分型MSCT评价及临床应用探讨[J]. 中国临床解剖学杂志, 2025, 43(1): 31-39.
[7]	张磊, 唐湘宇, 姜璐, 杨思艺, 周鑫, 柳天宇, 汪国友. Kager脂肪垫的分类及其与后踝撞击综合征的关系[J]. 中国临床解剖学杂志, 2025, 43(1): 40-44.
[8]	陈永龙, 王伟, 陈炯灰, 张镇武, 李俊, 杨志超, 黄春明, 李小川. 退行性腰椎侧弯患者L3椎弓根形态变异及其临床意义[J]. 中国临床解剖学杂志, 2025, 43(1): 45-53.
[9]	赵婷婷, 宋爽, 石科, 李晓英, 李攀阳, 李宁宁. 食管癌中miRNA枢纽靶基因的鉴定和验证[J]. 中国临床解剖学杂志, 2025, 43(1): 54-62.
[10]	莫娟梅, 张顺荣, 李健, 王振宁, 唐伟智, 梁碧琦, 庞宇舟, 周建龙, 周韶璋, 黄国东. 壮药扶正方通过改善Lewis肺癌CD8⁺ T细胞耗竭提高PD-L1抑制剂疗效的机制研究[J]. 中国临床解剖学杂志, 2025, 43(1): 63-68.
[11]	王鹏, 张德宝, 张杨, 张海斌, 时嘉, 张少杰, 李树文, 吴一民. 自体黄韧带干预TGF-β1/Smad3信号通路抑制兔硬膜外纤维瘢痕形成的实验研究[J]. 中国临床解剖学杂志, 2025, 43(1): 69-75.
[12]	李伟君, 周沂, 吴建辉, 陈丽华, 刘海英, 翟丽东. TVT与TVT-O不同位置治疗老年女性压力性尿失禁的有限元分析[J]. 中国临床解剖学杂志, 2025, 43(1): 76-81.
[13]	何一波, 罗张风, 田宇, 蒋帅, 谢龙辉, 邵怡雯, 李莉, 饶利兵. 数字定位结合3D打印经皮穿刺导板在股骨颈骨折内固定治疗中的应用[J]. 中国临床解剖学杂志, 2025, 43(1): 90-96.
[14]	刘龙奇, 史良, 王科大, 苏亦兵. 电生理监测显微手术治疗脊髓髓内肿瘤的手术效果及预后随访研究[J]. 中国临床解剖学杂志, 2025, 43(1): 97-101.
[15]	邓棕元, 陈崇, 梁国彦, 叶勇裕, 余正然, 余涛, 汪露通, 梁昌详, 昌耘冰. 铁死亡介导椎间盘退变的研究进展[J]. 中国临床解剖学杂志, 2025, 43(1): 102-106.