微侵入经皮钢板植入技术结合锁定加压钢板与普通钢板治疗胫骨远端粉碎性骨折的临床评价

Clinical evaluation of minimally invasive percutaneous plate osteosynthesis with locking compressive plate and conventional plate for fixation of distal tibial comminuted fractures

目的应用微侵入经皮钢板植入技术(MIPPO)植入锁定加压钢板(LCP)与常规切口普通钢板治疗胫骨远端粉碎性骨折,评价并比较两种方法的临床效果。方法105例胫骨远端粉碎性骨折患者随机分为MIPPO组(53例)和常规组(52例),MIPPO组置入LCP,常规组置入普通钢板,对两种术式的切口长度、出血量、手术时间、住院时间、骨折愈合时间、术后功能等指标进行比较。结果91例获11～38(23.5±9.58)个月随访。MIPPO组较常规组切口小[MIPPO组为(5.2±1.35)cm,常规组为(11.3±2.69)cm,P<0.05],出血量少[MIPPO组为(122±45.8)ml,常规组为(260±40.3)ml,P<0.05],手术时间短[MIPPO组(45.3±18.5)min,常规组(67.3±22.3)min,P<0.05]。常规组1例出现骨不连并再次手术,余患者骨折均愈合良好。两组间平均住院时间、骨折愈合时间、术后功能评价比较差异均无统计学意义。结论MIPPO技术结合LCP与普通钢板均为较好治疗胫骨远端粉碎性骨折的方法,应用MIPPO技术结合LCP更具有优势,可减少手术损伤,间接提高治疗成功率,有利于患者肢体功能的恢复。

Objective To investigate the clinical effect of minimally invasive percutaneous plate osteosynthesis（MIPPO） with locking compressive plate（LCP） and conventional plate for fixation of distal tibial comminuted fractures.Methods MIPPO technique was applied in 53 out of 105 cases,classic technique for fixation was applied in the other cases.Length of the incision,blood loss,operating time,hospital stay,fracture healing time and postoperative function were compared.Results 91 patients were followed up for 11～38 months（mean 23.5±9.58 months）,one cases sustained bone nonunion and got revision and the others had successful got bone union with mean time 3.1 months of MIPPO group and 3.4 months of classic incision group.The length of incision was（5.2±1.35）cm in MIPPO group and（11.3±2.69）cm in conventional group;blood loss was（122±45.8）ml in MIPPO group and（260±40.3）ml in conventional group;operation time was（45.3±18.5）min in MIPPO group and（67.3±22.3）min in conventional group.The differences were significant（P〈0.05）.Mean original hospistal stay,bone union time and fuctional results were not significant different.Conclusions Application of minimally invasive percutuneous plate osteosynthesis with LCP as a superior option compared with conventional plate will be a better choice for fixation of distal tibial comminuted fractures.