[1]郝连升,王新昌,陈健,等.微创经皮钢板内固定与切开复位内固定治疗闭合性胫骨远端骨折的对比研究[J].中医正骨,2016,28(10):14-17，23.
　HAO Liansheng,WANG Xinchang,CHEN Jian,et al.A retrospective trial of minimally invasive percutaneous plate osteosynthesis versus open reduction internal fixation for treatment of closed distal tibial fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(10):14-17，23.
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微创经皮钢板内固定与切开复位内固定治疗闭合性胫骨远端骨折的对比研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期数:
2016年10期
页码:
14-17，23
栏目:
临床研究
出版日期:
2016-10-20

文章信息/Info

Title:
A retrospective trial of minimally invasive percutaneous plate osteosynthesis versus open reduction internal fixation for treatment of closed distal tibial fractures
作者:
郝连升; 王新昌; 陈健; 黄峰
山东省聊城市中医医院,山东 聊城 252000
Author(s):
HAO Liansheng; WANG Xinchang; CHEN Jian; HUANG Feng
Liaocheng Hospital of Traditional Chinese Medicine,Liaocheng 252000,Shandong,China
关键词:
胫骨骨折;  骨折; 闭合性;  外科手术; 微创性;  骨折固定术; 内;  疗效比较研究
Keywords:
tibial fractures;  fractures; closed;  surgical procedures; minimally invasive;  fracture fixation; internal;  comparative effectiveness research
摘要:
目的:比较微创经皮钢板内固定(minimally invasive percutaneous plate osteosynthesis,MIPPO)与切开复位内固定治疗闭合性胫骨远端骨折的临床疗效及安全性。方法:回顾性分析82例闭合性胫骨远端骨折患者的病例资料,其中47例采用MIPPO治疗、35例采用切开复位内固定治疗。男67例,女15例。年龄19～67岁,中位数39岁。左侧31例,右侧51例。根据骨折AO分型,A型61例、B型13例、C型8例。合并腓骨骨折69例,其中腓骨中上1/3骨折23例、中下1/3骨折46例。受伤至手术时间1～5 d,中位数3 d。比较2组患者的手术时间、切口长度、术中出血量、术后1 d疼痛数字分级评分、骨折愈合时间及术后16个月的Baird-Jackson踝关节功能评分,并观察并发症发生情况。结果:所有患者均获得了16个月的随访。2组患者的手术时间比较,差异无统计学意义[(46.83±2.14)min,(50.76±1.38)min,t=1.761,P=0.953]; MIPPO组的切口长度、术中出血量、骨折愈合时间、疼痛数字分级评分及Baird-Jackson踝关节功能评分均优于切开复位内固定组[(8.15±1.02)cm,(23.65±2.46)cm,t=2.794,P=0.031;(80.32±10.09)mL,(253.76±27.12)mL,t=3.642,P=0.025;(80.32±10.09)d,(119.32±7.13)d,t=2.014,P=0.039;(2.19±0.72)分,(5.74±1.46)分,t=2.173,P=0.041;(96.83±2.14)分,(80.76±1.38)分,t=2.592,P=0.025]。MIPPO组4例骨折延迟愈合,未出现切口感染及钢板外露等并发症。切开复位内固定组2例术后9个月骨折未愈合,行髂骨植骨钢板内固定术; 2例发生切口感染,清创换药后愈合; 1例发生钢板外露及切口感染,清创、抗感染治疗后行皮瓣转移术。2组患者并发症发生率比较,差异无统计学意义(χ2=0.221,P=0.638)。结论:MIPPO治疗闭合性胫骨远端骨折,手术时间及安全性与切开复位内固定相当,但其具有切口小、术中出血量少、术后疼痛轻、骨折愈合时间短、踝关节功能恢复好等优点,值得临床推广应用。
Abstract:
Objective:To compare the clinical curative effects and safety of minimally invasive percutaneous plate osteosynthesis(MIPPO)versus open reduction internal fixation(ORIF)in the treatment of closed distal tibial fractures.Methods:The medical records of 82 patients with closed distal tibial fractures were analyzed retrospectively.Forty-seven patients were treated with MIPPO(MIPPO group),while the others were treated with open reduction and internal fixation(ORIF group).The patients consisted of 67 males and 15 females,and ranged in age from 19 to 67 years(Median=39 yrs).The fractures located in left tibia for 31 patients and right tibia for 51 patients.According to the AO classification of fracture,the tibial fractures belonged to types A(61),B(13)and C(8).Tibial fractures combined with fibular fractures were found in 69 patients,and the fibular fractures were located at top third of fibula in 23 patients and bottom third of fibula in 46 patients.The patients ranged in disease course from 1 to 5 days(Median=3 days).The operative time,incision length,blood loss,pain numerical rating scale(NRS)score at 1 day after surgery,fracture healing time and Baird-Jackson ankle function scores at 16 months after surgery and complication incidences were evaluated and compared between the 2 groups.Results:All patients in the 2 groups were followed up for 16 months.There was no statistical difference in the operative time between the 2 groups(46.83+/-2.14 vs 50.76+/-1.38 min,t=1.761,P=0.953).The MIPPO group surpassed the ORIF group in incision length,blood loss,fracture healing time,pain NRS scores and Baird-Jackson ankle function scores(8.15+/-1.02 vs 23.65+/-2.46 cm,t=2.794,P=0.031; 80.32+/-10.09 vs 253.76+/-27.12 mL,t=3.642,P=0.025; 80.32+/-10.09 vs 119.32+/-7.13 d,t=2.014,P=0.039; 2.19+/-0.72 vs 5.74+/-1.46 points,t=2.173,P=0.041; 96.83+/-2.14 vs 80.76+/-1.38 points,t=2.592,P=0.025).The delayed union of fractures were found in 4 patients and no complication such as incision infection and plate exposure were found in MIPPO group; while non-union of fractures(2),incision infection(2)and plate exposure combined with incision infection(1)were found in ORIF group.There was no statistical difference in complication incidences between the two groups(χ2=0.221,P=0.638).Conclusion:MIPPO is similar to ORIF in operative time and safety in treatment of closed distal tibial fractures,while the former has the advantages of smaller incision,less intraoperative blood loss,less postoperative pain,shorter fracture healing time and better ankle functional recovery,so it is worthy of popularizing in clinic.

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更新日期/Last Update: 2016-10-20