Jeremic Danilo, Grubor Nikola, Bascarevic Zoran, Slavkovic Nemanja, Krivokapic Branislav, Vukomanovic Boris, Davidovic Kristina, Jovanovic Zelimir, Tomic Slavko
Institute for Orthopeadics "Banjica", 11000 Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
J Clin Med. 2024 Mar 31;13(7):2034. doi: 10.3390/jcm13072034.
: The external fixation (EF) Ilizarov method, shown to offer efficacy and relative safety, has unique biomechanical properties. Intramedullary nail fixation (IMN) is an advantageous alternative, offering biomechanical stability and a minimally invasive procedure. The aim of this study was to assess outcomes in patients undergoing tibia fracture fixation, comparing the Ilizarov EF and IMN methods in an early phase of IMN implementation in Serbia. This was a retrospective study including patients with radiologically confirmed closed and open (Gustilo and Anderson type I) tibial diaphysis fractures treated at the Institute for Orthopedic Surgery "Banjica'' from January 2013 to June 2017. The following demographic and clinical data were retrieved: age, sex, chronic disease diagnoses, length of hospital stay, surgical wait times, surgery length, type of anesthesia used, fracture, prophylaxis, mechanism of injury, postsurgical complications, time to recovery, and pain reduction. Pain intensity was measured by the Visual Analog Scale (VAS), a self-reported scale ranging from 0 to 100 mm. A total of 58 IMN patients were compared to 74 patients who underwent Ilizarov EF. Study groups differed in time to recovery ( < 0.001), length of hospitalization ( = 0.007), pain intensity at the fracture site ( < 0.001), and frequency of general anesthesia in favor of intramedullary fixation ( < 0.001). A shorter surgery time ( < 0.001) and less antibiotic use ( < 0.001) were observed when EF was used. Additionally, we identified that the intramedullary fixation was a significant predictor of pain intensity. The IMN method offers faster recovery and reduced pain intensity in comparison to EF, while the length of surgery predicted the occurrence of any complication.
已证明，具有独特生物力学特性的外固定（EF）伊里扎洛夫方法具有疗效和相对安全性。髓内钉固定（IMN）是一种有利的替代方法，可提供生物力学稳定性且手术创伤小。本研究的目的是评估在塞尔维亚早期实施IMN时，接受胫骨骨折固定的患者的治疗效果，比较伊里扎洛夫EF和IMN方法。这是一项回顾性研究，纳入了2013年1月至2017年6月在“班吉察”骨外科研究所接受治疗的经放射学确诊的闭合性和开放性（Gustilo和Anderson I型）胫骨干骨折患者。收集了以下人口统计学和临床数据：年龄、性别、慢性病诊断、住院时间、手术等待时间、手术时长、所用麻醉类型、骨折情况、预防措施、损伤机制、术后并发症、恢复时间和疼痛减轻情况。疼痛强度通过视觉模拟量表（VAS）测量，这是一种自我报告量表，范围为0至100毫米。总共将58例IMN患者与74例接受伊里扎洛夫EF治疗的患者进行了比较。研究组在恢复时间（<0.001）、住院时间（=0.007）、骨折部位疼痛强度（<0.001）以及全身麻醉频率方面存在差异，髓内固定更具优势（<0.001）。使用EF时观察到手术时间更短（<0.001）且抗生素使用更少（<0.001）。此外，我们发现髓内固定是疼痛强度的一个重要预测因素。与EF相比，IMN方法恢复更快且疼痛强度降低，而手术时长可预测任何并发症的发生。
