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[1]郝連升,王新昌,陳健,等.微創(chuàng)經(jīng)皮鋼板內(nèi)固定與切開(kāi)復(fù)位內(nèi)固定治療閉合性脛骨遠(yuǎn)端骨折的對(duì)比研究[J].中醫(yī)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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微創(chuàng)經(jīng)皮鋼板內(nèi)固定與切開(kāi)復(fù)位內(nèi)固定治療閉合性脛骨遠(yuǎn)端骨折的對(duì)比研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期數(shù):
2016年10期
頁(yè)碼:
14-17，23
欄目:
臨床研究
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:
郝連升; 王新昌; 陳健; 黃峰
山東省聊城市中醫(yī)醫(yī)院,山東 聊城 252000
Author(s):
HAO Liansheng; WANG Xinchang; CHEN Jian; HUANG Feng
Liaocheng Hospital of Traditional Chinese Medicine,Liaocheng 252000,Shandong,China
關(guān)鍵詞:
脛骨骨折;  骨折; 閉合性;  外科手術(shù); 微創(chuàng)性;  骨折固定術(shù); 內(nèi);  療效比較研究
Keywords:
tibial fractures;  fractures; closed;  surgical procedures; minimally invasive;  fracture fixation; internal;  comparative effectiveness research
摘要:
目的:比較微創(chuàng)經(jīng)皮鋼板內(nèi)固定(minimally invasive percutaneous plate osteosynthesis,MIPPO)與切開(kāi)復(fù)位內(nèi)固定治療閉合性脛骨遠(yuǎn)端骨折的臨床療效及安全性。方法:回顧性分析82例閉合性脛骨遠(yuǎn)端骨折患者的病例資料,其中47例采用MIPPO治療、35例采用切開(kāi)復(fù)位內(nèi)固定治療。男67例,女15例。年齡19～67歲,中位數(shù)39歲。左側(cè)31例,右側(cè)51例。根據(jù)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。受傷至手術(shù)時(shí)間1～5 d,中位數(shù)3 d。比較2組患者的手術(shù)時(shí)間、切口長(zhǎng)度、術(shù)中出血量、術(shù)后1 d疼痛數(shù)字分級(jí)評(píng)分、骨折愈合時(shí)間及術(shù)后16個(gè)月的Baird-Jackson踝關(guān)節(jié)功能評(píng)分,并觀察并發(fā)癥發(fā)生情況。結(jié)果:所有患者均獲得了16個(gè)月的隨訪。2組患者的手術(shù)時(shí)間比較,差異無(wú)統(tǒng)計(jì)學(xué)意義[(46.83±2.14)min,(50.76±1.38)min,t=1.761,P=0.953]; MIPPO組的切口長(zhǎng)度、術(shù)中出血量、骨折愈合時(shí)間、疼痛數(shù)字分級(jí)評(píng)分及Baird-Jackson踝關(guān)節(jié)功能評(píng)分均優(yōu)于切開(kāi)復(fù)位內(nèi)固定組[(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組4例骨折延遲愈合,未出現(xiàn)切口感染及鋼板外露等并發(fā)癥。切開(kāi)復(fù)位內(nèi)固定組2例術(shù)后9個(gè)月骨折未愈合,行髂骨植骨鋼板內(nèi)固定術(shù); 2例發(fā)生切口感染,清創(chuàng)換藥后愈合; 1例發(fā)生鋼板外露及切口感染,清創(chuàng)、抗感染治療后行皮瓣轉(zhuǎn)移術(shù)。2組患者并發(fā)癥發(fā)生率比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(χ2=0.221,P=0.638)。結(jié)論:MIPPO治療閉合性脛骨遠(yuǎn)端骨折,手術(shù)時(shí)間及安全性與切開(kāi)復(fù)位內(nèi)固定相當(dāng),但其具有切口小、術(shù)中出血量少、術(shù)后疼痛輕、骨折愈合時(shí)間短、踝關(guān)節(jié)功能恢復(fù)好等優(yōu)點(diǎn),值得臨床推廣應(yīng)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