Kruppa Christiane G, Hoffmann Martin F, Sietsema Debra L, Mulder Michelle B, Jones Clifford B
*Grand Rapids Medical Education Partners, Grand Rapids, MI; †Department of Surgery, BG University Hospital Bergmannsheil, Bochum, Germany; ‡College of Human Medicine, Michigan State University, Grand Rapids, MI; §Orthopaedic Associates of Michigan, Grand Rapids, MI; and ‖School of Medicine, Wayne State University, Detroit, MI.
J Orthop Trauma. 2015 Sep;29(9):e309-15. doi: 10.1097/BOT.0000000000000323.
To determine outcomes in the treatment of distal tibial fractures treated with intramedullary nails.
Retrospective analysis.
Level I trauma center with follow-up in a private orthopaedic practice.
Radiographic determination of alignment, nonunion, and malunion, clinical outcome (range of motion, and implant-associated complaints), wound complications, and fibular fixation.
A total of 105 patients with OTA/AO type A and C tibial fractures (<11 cm from the joint line) treated with intramedullary nailing.
Distance of the fracture from the joint line averaged 6.1 cm (range, 0-11). Mean follow-up was 25.6 months (range, 12-74). Nonunion occurred in 20 (19%) fractures and were significantly associated with open fractures (P = 0.012), wound complications (P < 0.001), and the need for fibular fixation (P = 0.007). Sagittal plane alignment averaged 2.5 degrees (±4.4) valgus. Malunion occurred in 25 (23.8%) fractures and again were significantly associated with open fractures (P = 0.045). Fifty (47.6%) patients had implant-related pain, which resolved in 27 (54.0%) after removal.
Intramedullary nailing of distal tibial fractures is a suitable treatment option. Acceptable alignment and range of motion can be achieved. Both nonunions and malunions were significantly associated with open fractures, wound complications, and fibular fixation. Implant removal was needed in 25% of cases.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
确定使用髓内钉治疗胫骨干骺端骨折的疗效。
回顾性分析。
一级创伤中心，在一家私立骨科诊所进行随访。
通过影像学确定对线、骨不连和畸形愈合情况，临床疗效（活动范围和与植入物相关的主诉）、伤口并发症以及腓骨固定情况。
总共105例接受髓内钉治疗的OTA/AO A型和C型胫骨干骺端骨折（距关节线<11 cm）患者。
骨折部位距关节线的平均距离为6.1 cm（范围0 - 11 cm）。平均随访时间为25.6个月（范围12 - 74个月）。20例（19%）骨折发生骨不连，并与开放性骨折（P = 0.012）、伤口并发症（P < 0.001）以及腓骨固定需求（P = 0.007）显著相关。矢状面平均对线为外翻2.5°（±4.4°）。25例（23.8%）骨折发生畸形愈合，同样与开放性骨折显著相关（P = 0.045）。50例（47.6%）患者有与植入物相关的疼痛，其中27例（54.0%）在取出植入物后疼痛缓解。
胫骨干骺端骨折髓内钉固定是一种合适的治疗选择。可实现可接受的对线和活动范围。骨不连和畸形愈合均与开放性骨折、伤口并发症以及腓骨固定显著相关。25%的病例需要取出植入物。
治疗性四级证据。有关证据级别的完整描述，请参阅《作者须知》。
