解剖 

胫腓骨骨折在全身骨折中最为常见，其中以胫骨干单骨折最多，胫腓骨干双骨折次之，腓骨干单骨折最少。

创伤特点 

骨筋膜室综合征10%~50%（后深、前侧间室）。

粉碎骨折或者多节段骨折多合并软组织损伤。

并发症多：愈合障碍、骨缺血坏死、骨髓炎等。

 治疗 

关于胫骨干骨折采用手术和非手术治疗的指征日益明显。

虽然非手术治疗在过去经常受到推崇，但现在仅用于治疗由低能量外伤引起的闭合、稳定、单纯、微小移位的骨折和一些稳定的低速的枪伤骨折。

但是闭合治疗需要制动，这可能对踝关节的活动有不良影响。文献报道，接受闭合治疗的患者踝关节僵硬发生率为20%~30%，采用支具或石膏治疗后，10%~55%的骨折发生了超过5°的成角畸形，而5%~27%的患者发生了超过12-14mm的短缩畸形。

手术治疗则适于高能量外伤引起的大多数胫骨骨折。此类骨折大多是不稳定和粉碎的，并伴有不同程度的软组织外伤。治疗的目的是获得骨折的愈合和良好的对线、消除负重疼痛和获得膝、踝关节有用的活动范围。最佳的治疗方法应达到这些目的，同时减少并发症，尤其是感染。

 对比概括 

髓内钉被认为是内固定治疗闭合性胫骨干骨折的金标准，与MIPPO钢板相比，髓内钉是否真的存在明显优势？

为研究髓内钉与MIPPO在治疗闭合性胫骨干骨折中的疗效与并发症差异，国外学者进行了对比研究，相关结果发表在2021.04期Injury期刊上。

对比介绍 

髓内钉(IMN)目前被认为是治疗成人胫骨干骨折的金标准。在这项病例对照比较研究中，我们旨在比较微创钢板接骨术(MIPO)和IMN治疗胫骨干骨折的疗效。[Introduction: Intramedullary nailing (IMN) is currently considered the gold standard in the surgical treatment of tibial shaft fractures in adult patients. In this case-control comparative study, we aimed to compare the efficacy of minimally invasive plate osteosynthesis (MIPO) and IMN in treating tibial shaft fractures.]

 实验 

评估了IMN和MIPO治疗胫骨干骨折的临床和放射学结果，如改良创伤评分、手术时间、骨折愈合、再手术率以及并发症，如畸形愈合、不愈合、短缩和感染。

[Materials and methods: The clinical and radiological outcomes, such as a modified trauma scale, operation time, fracture healing, rate of re-operation, and complications such as malunion, nonunion, shortening, and infection were assessed between IMN and MIPO for the treatment of tibial shaft fractures.]

▲表1：两组基线资料。

 结果 

对2010年6月至2016年5月因闭合性胫骨干关节外骨折(AO/OTA 42)接受IMN(组一)或MIPO(组二)治疗的73例骨骼成熟患者进行回顾性分析。平均年龄51.16 (18~79)岁，平均随访时间22 (12~50)个月。除IMN组(35例)和MIPO组(36例)各1例外，其余病例均骨性愈合(p > 0.05)。两组均在12(8-16)周观察到平均骨痂形成(p > 0.05)。两组在手术时间、住院时间、骨愈合及并发症发生率方面无显著性差异(p > 0.05)。两种方法术后功能评价无差异(p > 0.05)。[Results: Seventy-three skeletally mature patients who underwent IMN (group I) or MIPO (group M) for a closed extra-articular tibial shaft fracture (AO/OTA type 42) from June 2010 to May 2016 were retrospectively reviewed. The mean age was 51.16 (18~79) years, and the mean follow-up period was 22 (12~50) months. Bony union was achieved in all cases but one for each group - group I (35 cases) and group M(36 cases) (p > 0.05). Mean callus formation was observed in 12 (8 – 16) weeks in both groups (p > 0.05). There was no significant difference in operative time, hospital stay, bone healing, and the rate of complications among the two groups (p > 0.05). There was also no postoperative difference in functional evaluation between the two methods (p > 0.05).]

表2：两组结局指标

表3：两组并发症发生风险的Logistic回归分析。

 结果 

IMN和MIPO在胫骨干骨折的影像学和临床结果方面没有发现差异。可以得出结论，IMN和MIPO都是治疗胫骨干骨折的有效方法。

[Conclusions: No discrepancy was found in radiological and clinical outcomes between IMN and MIPO for tibial shaft fractures. It can be concluded that both IMN and MIPO are equally effective treatment modalities for tibial shaft fractures.]