PDF(Pubmed)
Abstract：
BACKGROUND: Distal tibial fractures represent common lower limb injuries, frequently accompanied by significant soft tissue damage. The optimal surgical approach for managing these fractures remains a topic of considerable debate. The aim of this study was to perform a comparative analysis of the outcomes associated with retrograde intramedullary tibial nails (RTN) and minimally invasive plate osteosynthesis (MIPO) in the context of treating extra-articular distal tibial fractures.
METHODS: A retrospective review was conducted on a cohort of 48 patients who sustained extra-articular distal tibial fractures between December 2019 and December 2021. Patients underwent either RTN or MIPO procedures. Various parameters, including operative duration, intraoperative fluoroscopy exposure, time to union, duration until full weight-bearing, American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications, were recorded and compared between the two treatment groups.
RESULTS: No statistically significant differences were observed in operative duration, time to union, angulation of the distal tibial coronal plane, or AOFAS scores between the RTN and MIPO groups. However, the RTN group had a higher average number of intraoperative fluoroscopy images (8.2 ± 2.3) compared to the MIPO group (4.1 ± 2.0). The RTN group demonstrated shorter average hospital stays (7.1 ± 1.4 days) and a quicker return to full weight-bearing (9.9 ± 1.3 weeks), which were significantly superior to the MIPO group (9.0 ± 2.0 days and 11.5 ± 1.5 weeks, respectively). In terms of complications, the RTN group had one case of superficial infection, whereas the MIPO group exhibited two cases of delayed union and nonunion, two occurrences of deep infection, and an additional three cases of superficial infection.
CONCLUSIONS: Both RTN and MIPO are effective treatment options for extra-articular distal tibial fractures. However, RTN may offer superior outcomes in terms of decreased inpatient needs, faster return to full weight-bearing capacity, and a lower rate of complications.
METHODS: A retrospective review was conducted on a cohort of 48 patients who sustained extra-articular distal tibial fractures between December 2019 and December 2021. Patients underwent either RTN or MIPO procedures. Various parameters, including operative duration, intraoperative fluoroscopy exposure, time to union, duration until full weight-bearing, American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications, were recorded and compared between the two treatment groups.
RESULTS: No statistically significant differences were observed in operative duration, time to union, angulation of the distal tibial coronal plane, or AOFAS scores between the RTN and MIPO groups. However, the RTN group had a higher average number of intraoperative fluoroscopy images (8.2 ± 2.3) compared to the MIPO group (4.1 ± 2.0). The RTN group demonstrated shorter average hospital stays (7.1 ± 1.4 days) and a quicker return to full weight-bearing (9.9 ± 1.3 weeks), which were significantly superior to the MIPO group (9.0 ± 2.0 days and 11.5 ± 1.5 weeks, respectively). In terms of complications, the RTN group had one case of superficial infection, whereas the MIPO group exhibited two cases of delayed union and nonunion, two occurrences of deep infection, and an additional three cases of superficial infection.
CONCLUSIONS: Both RTN and MIPO are effective treatment options for extra-articular distal tibial fractures. However, RTN may offer superior outcomes in terms of decreased inpatient needs, faster return to full weight-bearing capacity, and a lower rate of complications.
摘要：
背景：胫骨远端骨折是常见的下肢损伤，经常伴有明显的软组织损伤。治疗这些骨折的最佳手术方法仍然是一个有争议的话题。这项研究的目的是对逆行胫骨髓内钉（RTN）和微创钢板接骨术（MIPO）治疗胫骨远端关节外骨折的结果进行比较分析。
方法：对2019年12月至2021年12月期间48例胫骨远端关节外骨折患者进行回顾性研究。患者接受RTN或MIPO手术。各种参数，包括手术持续时间，术中透视暴露，工会的时间，持续时间直到完全承重，美国骨科足踝协会（AOFAS）评分，和并发症，记录并比较两个治疗组。
结果：手术时间无统计学差异，工会的时间，胫骨远端冠状平面的角度，或RTN和MIPO组之间的AOFAS得分。然而,与MIPO组(4.1±2.0)相比,RTN组术中透视图像的平均数量(8.2±2.3)更高.RTN组显示出更短的平均住院时间（7.1±1.4天）和更快的恢复到完全负重（9.9±1.3周），显著优于MIPO组(9.0±2.0天和11.5±1.5周,分别)。在并发症方面,RTN组出现1例浅表感染,而MIPO小组表现出两起延迟工会和不工会的案例，两次发生深部感染,和另外三例浅表感染。
结论：RTN和MIPO均是治疗胫骨远端关节外骨折的有效选择。然而,RTN可能在降低住院患者需求方面提供更好的结果，更快地恢复到全部承重能力，并发症发生率较低。
方法：对2019年12月至2021年12月期间48例胫骨远端关节外骨折患者进行回顾性研究。患者接受RTN或MIPO手术。各种参数，包括手术持续时间，术中透视暴露，工会的时间，持续时间直到完全承重，美国骨科足踝协会（AOFAS）评分，和并发症，记录并比较两个治疗组。
结果：手术时间无统计学差异，工会的时间，胫骨远端冠状平面的角度，或RTN和MIPO组之间的AOFAS得分。然而,与MIPO组(4.1±2.0)相比,RTN组术中透视图像的平均数量(8.2±2.3)更高.RTN组显示出更短的平均住院时间（7.1±1.4天）和更快的恢复到完全负重（9.9±1.3周），显著优于MIPO组(9.0±2.0天和11.5±1.5周,分别)。在并发症方面,RTN组出现1例浅表感染,而MIPO小组表现出两起延迟工会和不工会的案例，两次发生深部感染,和另外三例浅表感染。
结论：RTN和MIPO均是治疗胫骨远端关节外骨折的有效选择。然而,RTN可能在降低住院患者需求方面提供更好的结果，更快地恢复到全部承重能力，并发症发生率较低。
