钢板与髓内钉：对于严重胫骨骨折，是否存在更有效的植入物？
Plate vs. Nail: Is there a more effective implant for extreme tibia fractures?
作者信息
Ganta Abhishek, Cherry Fiona K, Tejwani Nirmal C, Konda Sanjit R, Egol Kenneth A
机构信息
NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY, 10003, USA.
Jamaica Hospital Medical Center, Queens, NY, 11418, USA.
出版信息
J Clin Orthop Trauma. 2025 Apr 21;65:103025. doi: 10.1016/j.jcot.2025.103025. eCollection 2025 Jun.
BACKGROUND
The purpose of this study is to determine differences in outcomes between "extreme" tibial metaphyseal fractures treated with intramedullary nailing (IMN) or plate osteosynthesis.
METHODS
545 prospectively collected patients were reviewed by two board-certified orthopedic trauma surgeons to identify extreme tibial shaft fractures (defined as most proximal or distal segments that involved or would have involved the area encompassed by the nail locking bolts). Fifty-one patients were identified. Twenty-five patients treated with an intramedullary nail were compared to 24 patients treated with plate and screws for similar patterns. Data collected included patient demographics, surgical details, and outcomes. Cohorts were compared using fisher's exact test, independent T tests, and multivariable linear regression.
RESULTS
The mean age of all patients was 46.73 years. There were no differences in ASA, CCI, age, male/female composition, or BMI between cohorts. There were no differences in low vs. high-energy mechanism of injury between cohorts, however the IMN cohort had a greater proportion of open fractures (p = 0.018). When controlling for covariates, patients who underwent IMN were allowed earlier weight bearing on the operative extremity. There were no differences in ankle or knee range of motion at latest follow up. There was a greater incidence of total complications among IMN (p = 0.033). Single variable analysis revealed an association between IMN and nonunion (p = 0.050). IMN trended towards greater need for reoperation (p = 0.086).
CONCLUSION
Intramedullary nailing of "extreme tibia fractures" was associated with higher rates of total complications compared to plate osteosynthesis and trended with greater need for reoperation. However, it should be noted that there was a higher incidence of open fractures in this cohort. There were no differences in the rate of malalignment, range of motion, or time to healing between cohorts.
背景
本研究的目的是确定采用髓内钉固定（IMN）或钢板内固定治疗“极端”胫骨干骺端骨折的疗效差异。
方法
两位获得委员会认证的骨科创伤外科医生对545例前瞻性收集的患者进行了评估，以确定极端胫骨干骨折（定义为最近端或最远端节段，涉及或可能涉及髓内钉锁定螺栓所覆盖的区域）。共识别出51例患者。将25例接受髓内钉治疗的患者与24例接受钢板螺钉治疗的具有相似骨折类型的患者进行比较。收集的数据包括患者人口统计学资料、手术细节和疗效。采用Fisher精确检验、独立样本t检验和多变量线性回归对队列进行比较。
结果
所有患者的平均年龄为46.73岁。两组在ASA、CCI、年龄、男女构成或BMI方面无差异。两组在低能量与高能量损伤机制方面无差异，但髓内钉组开放性骨折的比例更高（p = 0.018）。在控制协变量后，接受髓内钉治疗的患者允许更早地对手术肢体进行负重。在最新随访时，踝关节或膝关节活动范围无差异。髓内钉组的总并发症发生率更高（p = 0.033）。单变量分析显示髓内钉与骨不连之间存在关联（p = 0.050）。髓内钉组再次手术的需求有增加趋势（p = 0.086）。
结论
与钢板内固定相比，“极端胫骨骨折”的髓内钉固定总并发症发生率更高，再次手术的需求也有增加趋势。然而，应注意的是，该队列中开放性骨折的发生率较高。两组在畸形愈合率、活动范围或愈合时间方面无差异。
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