摘要
目的探讨交锁髓内钉与锁定钢板治疗胫骨骨折的临床疗效及其对骨代谢的影响。方法选取2017年9月至2019年9月收治的80例胫骨骨折患者,随机分为A组(n=40)、B组(n=40),分别采用交锁髓内钉及锁定钢板治疗。记录并比较两组患者手术时间、住院时间、术中出血量、术后负重时间、骨折愈合时间、术后并发症、OMAS评分、EQ-5D评分,以及炎症应激指标和骨代谢生物标志物指标。利用多元Logistic回归分析影响骨折后负重时间的相关因素。结果A组患者手术时间、住院时间、骨折愈合时间均低于B组患者(P<0.05),A组术中出血量、术后负重时间明显高于B组(P<0.05)。A组术后1个月、3个月的OMAS评分以及术后3个月EQ-5D评分明显高于B组(P<0.05)。A组术后并发症较B组低,优良率较B组高(P<0.05)。术后48 h,A组患者抗炎因子IL-35、TGF-β水平明显高于B组;促炎因子IFN-γ、INF-α水平明显低于B组(P<0.05),但IL-1β水平明显高于B组(P<0.05)。术后1个月,A组患者骨形成标志物PINP、OPG、OC水平显著高于B组患者;骨吸收标志物TRAP、Cat K、DPD水平显著低于B组患者(P<0.05)。多元Logistic回归分析显示,手术方式、糖尿病、IFN-γ、DPD是影响骨折后负重时间的相关因素。结论交锁髓内钉治疗胫骨骨折疗效较好,术后并发症较低,更有利于骨代谢生物标志物以及炎症因子的平衡,可临床推广使用。
Objective To explore the clinical efficacy of interlocking intramedullary nail and locking plate in the treatment of tibial fractures and their influence on bone metabolism.Methods From September 2017 to September 2019,80 patients with tibial fracture were selected.The patients were randomly divided into group A(n=40)and group B(n=40),and were treated with interlocking intramedullary nail and locking plate,respectively.Operation time,hospital stay,intraoperative blood loss,postoperative loading time,fracture healing time,treatment effect,postoperative complications,OMAS score,EQ-5D score,inflammatory stress indexes and bone metabolism biomarkers were recorded and compared between the two groups.The multiple Logistic regression analysis was used to analyze the correlation factors of loading time after fracture.Results The operation time,hospital stay and fracture healing time in group A were all lower than those in group B(P<0.05),and the intraoperative blood loss and postoperative load time in group A were significantly higher than those in group B(P<0.05).The OMAS score 1,3 months after operation as well as EQ-5D score 3 months after operation in group A was significantly higher than that of group B(P<0.05).Postoperative complications in group A were lower than those in group B,and the good rate was higher than that in group B(P<0.05).Forty-eight hours after surgery,the levels of anti-inflammatory factors L-35 and TGF-βin group A were significantly higher than those in group B(P<0.05);The levels of pro-inflammatory factors IFN-γ,INF-αwere significantly lower than those in group B(P<0.05),but IL-1βlevel was significantly higher than that in group B(P<0.05).One month after surgery,the levels of bone formation markers PINP,OPG and OC were significantly higher than those in group B(P<0.05);The levels of bone resorption markers TRAP,Cat K and DPD were significantly lower than those in group B(P<0.05).The multiple Logistic regression analysis showed that operation method,diabetes mellitus,IFN-γand DPD were the re
作者
王博
郑红兵
马军
王杨
朱裕成
WANG Bo;ZHENG Hongbing;MA Jun;WANG Yang;ZHU Yucheng(Department of Orthopaedics,Suqian People′s Hospital of Nanjing Drum-Tower Hospital Group,Suqian 223800,China)
出处
《组织工程与重建外科杂志》
2020年第2期153-157,共5页
Journal of Tissue Engineering and Reconstructive Surgery
关键词
交锁髓内钉
锁定钢板
胫骨骨折
骨代谢
Interlocking intramedullary nail
Locking plate
Tibial fracture
Bone metabolism
