Liu Hui, Lin Weibin, Xu Weizhen, Xiong Yuanfei, Zhang Jinhui, Wu Jin
Department of Orthopaedics, the 909th Hospital, School of Medicine, Xiamen University, Zhanghua Road 269, Zhangzhou, Fujian, 363000, China.
Int Orthop. 2025 Jan;49(1):219-227. doi: 10.1007/s00264-024-06348-5. Epub 2024 Oct 12.
The aim of this study was to compare the effectiveness of retrograde and antegrade intramedullary tibial nails (RTN and ATN) in managing extra-articular distal tibial fractures, addressing current controversies in surgical approaches.
A retrospective analysis included 56 patients treated between December 2019 and August 2022 with either RTN (n = 23) or ATN (n = 33). Data on baseline characteristics, operative specifics, fluoroscopy usage, hospitalization duration, fracture healing times, time to full weight-bearing, distal tibial alignment, American Orthopedic Foot and Ankle Society (AOFAS) scores at final follow-up, and complications were evaluated and compared.
Baseline characteristics were generally comparable and no significant differences except for fracture line lengths (RTN: 6.1 ± 1.9 cm vs. ATN: 7.8 ± 1.6 cm) were observed. Follow-up ranged from 12 to 20 months. No significant differences were observed in operative duration, hospital stays, coronal angulation of the distal tibial joint surface, or AOFAS scores at final follow-up. Intraoperative fluoroscopy was more frequent in the ATN group (9.5 ± 1.5) compared to RTN (8.3 ± 1.1) (P = 0.001). RTN showed shorter healing times (9.6 ± 1.2 weeks) and quicker return to full weight-bearing (12.9 ± 1.3 weeks) than ATN (10.6 ± 1.2 weeks and 13.9 ± 1.7 weeks, respectively). RTN complications included one delayed union, one superficial infection, and two ankle pain, while ATN complications comprised one delayed union, one superficial infection, seven anterior knee pain, and one malalignment. Despite higher complication rates with ATN, the differences were not statistically significant.
For the treatment of extra-articular distal tibial fractures, both RTN and ATN are effective approaches. RTN may offer benefits such as reduced fluoroscopy use, accelerated healing, and earlier return to full weight-bearing compared to ATN.
本研究旨在比较逆行与顺行胫骨髓内钉（RTN和ATN）治疗胫骨干骺端关节外骨折的有效性，以解决当前手术方法上的争议。
一项回顾性分析纳入了2019年12月至2022年8月期间接受RTN（n = 23）或ATN（n = 33）治疗的56例患者。评估并比较了基线特征、手术细节、透视使用情况、住院时间、骨折愈合时间、完全负重时间、胫骨干骺端对线情况、末次随访时美国矫形足踝协会（AOFAS）评分以及并发症。
基线特征总体具有可比性，除骨折线长度外（RTN：6.1±1.9厘米 vs. ATN：7.8±1.6厘米）未观察到显著差异。随访时间为12至20个月。在手术时长、住院时间、胫骨干骺端关节面的冠状位成角或末次随访时的AOFAS评分方面未观察到显著差异。与RTN组（8.3±1.1）相比，ATN组术中透视更频繁（9.5±1.5）（P = 0.001）。与ATN（分别为10.6±1.2周和13.9±1.7周）相比，RTN显示出更短的愈合时间（9.6±1.2周）和更快恢复至完全负重（12.9±1.3周）。RTN并发症包括1例骨延迟愈合、1例浅表感染和2例踝关节疼痛，而ATN并发症包括1例骨延迟愈合、1例浅表感染、7例膝关节前方疼痛和1例对线不良。尽管ATN的并发症发生率较高，但差异无统计学意义。
对于胫骨干骺端关节外骨折的治疗，RTN和ATN都是有效的方法。与ATN相比，RTN可能具有减少透视使用、加速愈合和更早恢复至完全负重等优势。
