Kundu I K, Datta N K, Chowdhury A Z, Das K P, Tarik M M, Faisal M A
Dr Indrojit Kumar Kundu, Medical Officer, Department of Orthopaedic Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
Mymensingh Med J. 2016 Jul;25(3):495-9.
Fracture of tibial shaft is the commonest site of long bone fractures due to its superficial location involving young or middle-age people. Proper management is an important issue regarding the future effective movements. In this study patients were grouped in closed Intra medullary interlocking nailing and locking compression plating. Post-operative follow up at 2 weeks, 6 weeks, 12 weeks and 3 months thereafter up to 6 months were done. Each of the patients was evaluated clinically and radiologically by tucker criteria of Tuker et al. Patients were assessed for pain on full weight bearing and kneeling, shortening and range of motion of knee and ankle joints. Radiological assessment for union of fracture, alignment of fracture and angulations and position of nail and screws and infection were observed during follow up. A total number of 32 patients were selected but only 27 patients were available for follow up for a period of 6 months. They were grouped into Group A, consisting of 15 patients who took the treatment in the form of closed intramedullary interlocking nailing and Group B, consisting of 12 patients those underwent ORIF with locking compression plating. In both of the groups Motor Vehicle Accident was the main mechanism of trauma. Fracture involving the middle 3rd of the tibia is common in both the groups. During post-operative follow up, four patients in Group A complained anterior knee pain, one patient in Group B had superficial infection, most of the patients had no restriction of movement in the ankle and knee joints and a single patient in Group B showed 1.5cm shortening of the lower limb. Period of hospital stay and fracture union time were less in Group A, which was statistically significant. Both groups showed excellent result with minimum complications. So this study permits to conclude that close IM interlocking nailing and open reduction and internal fixation by locking compression plating is equally effective for the management of close fracture shaft of the tibia.
胫骨干骨折是长骨骨折最常见的部位，因其位置表浅，多见于年轻人或中年人。正确的治疗对于未来有效的活动至关重要。在本研究中，患者被分为闭合髓内交锁髓内钉固定组和锁定加压钢板固定组。术后分别在2周、6周、12周、3个月及之后直至6个月进行随访。根据Tuker等人的Tucker标准对每位患者进行临床和影像学评估。评估患者在完全负重和跪立时的疼痛情况、下肢缩短情况以及膝关节和踝关节的活动范围。随访期间观察骨折愈合情况、骨折对线和成角情况、髓内钉和螺钉位置以及有无感染等影像学表现。共选取32例患者，但只有27例患者完成了6个月的随访。他们被分为A组，共15例，采用闭合髓内交锁髓内钉治疗；B组，共12例，采用切开复位锁定加压钢板内固定治疗。两组患者的主要致伤机制均为机动车事故。两组中累及胫骨中1/3的骨折均较为常见。术后随访期间，A组有4例患者诉前膝关节疼痛，B组有1例患者发生表浅感染，大多数患者的踝关节和膝关节活动无受限，B组有1例患者下肢短缩1.5cm。A组的住院时间和骨折愈合时间较短，差异具有统计学意义。两组均取得了良好的效果，并发症最少。因此，本研究可以得出结论，闭合髓内交锁髓内钉固定和切开复位锁定加压钢板内固定治疗闭合性胫骨干骨折同样有效。
