Department of Orthopedic Trauma, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710054 Shaanxi Province, China.
Comput Math Methods Med. 2022 Apr 1;2022:4852201. doi: 10.1155/2022/4852201. eCollection 2022.
Lower-extremity deep vein thrombosis (DVT) is prone to occur after internal fixation of tibial fractures. This study analyzed the effect of intramedullary nailing (IMN) and plate fixation (PF) on lower-extremity DVT, providing reliable reference and guidance for future clinical treatment of tibial fractures. Sixty-eight patients with tibial fractures admitted to Honghui Hospital, Xi'an Jiaotong University, between February 2019 and October 2020 were selected as research participants, of which 32 cases treated with open reduction and locking-compression plate fixation were assigned to the FP group and 36 cases treated with closed reduction and interlocking IMN were included in the FN group. The two groups were compared regarding the following items: clinical efficacy, operation, rehabilitation, joint function, pain, inflammatory factors (IFs), incidence of adverse reactions (ARs), blood loss, prognosis, and quality of life (QoL). The related factors affecting the occurrence of DVT were analyzed. The results identified no evident difference in the overall response rate between the two groups ( > 0.05). The FN group showed longer operation time, higher incidence of ARs, and better rehabilitation, while there were lower incision length, VAS score, and IF levels ( < 0.05). The results revealed no significant difference in estnimated blood volume(EBV) and the incidence of DVT between the two groups( > 0.05); however, the total blood loss (TBL), hidden blood loss (HBL), and blood transfusion rates in FN group were higher while the visible blood loss (VBL) was lower compared to the FP group ( < 0.05). Logistic regression analysis identified that blood transfusion, VBL, HBL, TBL, and treatment methods were independent risk factors affecting the occurrence of lower-extremity DVT ( < 0.05). In addition, the prognostic QoL was better in the FN group ( < 0.05). Therefore, closed reduction and interlocking IMN are more effective than open reduction and locking-compression plate fixation in the treatment of tibial fractures, but patients are more likely to suffer from lower-extremity DVT. In the future, it is necessary to carefully choose the treatment method in the treatment of tibial fracture patients to ensure their rehabilitation.
下肢深静脉血栓形成（DVT）在胫骨骨折内固定后容易发生。本研究分析了髓内钉（IMN）和钢板固定（PF）对下肢 DVT 的影响，为胫骨骨折的临床治疗提供了可靠的参考和指导。
选取 2019 年 2 月至 2020 年 10 月西安交通大学红会医院收治的 68 例胫骨骨折患者作为研究对象，其中采用切开复位锁定加压钢板固定治疗的 32 例患者归入 FP 组，采用闭合复位交锁髓内钉固定治疗的 36 例患者归入 FN 组。比较两组患者的临床疗效、手术、康复、关节功能、疼痛、炎症因子（IFs）、不良反应（ARs）发生率、出血量、预后和生活质量（QoL）。分析影响 DVT 发生的相关因素。
结果显示，两组患者的总有效率比较差异无统计学意义（>0.05）。FN 组手术时间较长，ARs 发生率较高，康复情况较好，切口长度、VAS 评分和 IF 水平较低（<0.05）。两组患者的估计失血量（EBV）和 DVT 发生率比较差异无统计学意义（>0.05）；但 FN 组总出血量（TBL）、隐性出血量（HBL）和输血率较高，显性出血量（VBL）较低（<0.05）。Logistic 回归分析发现，输血、VBL、HBL、TBL 和治疗方法是影响下肢 DVT 发生的独立危险因素（<0.05）。此外，FN 组患者的预后 QoL 更好（<0.05）。
综上所述，闭合复位交锁髓内钉固定治疗胫骨骨折的效果优于切开复位锁定加压钢板固定，但患者更容易发生下肢 DVT。未来在治疗胫骨骨折患者时，有必要仔细选择治疗方法，以确保其康复。
