胫骨远端骨折三种手术方法疗效对比分析

Analysis of Three Approaches for the Treatment of the Distal Tibial Fracture

目的对比分析胫骨远端骨折三种手术方法的临床适应证和疗效。方法 2001年1月—2010年2月我科采用手术治疗胫骨远端骨折83例,分别采用切开复位内固定(OR IF)、经皮微创插入钢板内固定(M IPPO)及有限切开内固定辅助外固定架外固定3种手术方法治疗。结果 3组患者术后均随访,随访时间8个月～4年,平均(17±6.9)个月,按AOFAS评分标准评价术后功能,3组患者的术中术后出血量、骨折愈合时间、恢复工作时间、并发症发生率以及术后优良率比较,差异均无统计学意义(P>0.05),但手术时间M IPPO组明显长于其他两组,差异有统计学意义(P<0.05)。结论外固定是治疗严重骨折损伤安全有效的方法,ORIF可作为低能量损伤的最终治疗方法,MIPPO特别适于不涉及关节面的干骺端粉碎骨折。根据软组织条件和骨折类型,选择恰当手术时机和手术方法,均可有效避免并发症,获得满意疗效。

Objective To comparative analysis the effects and methods for treatment of the distal tibial fracture.Methods We analyzed the results of 83 cases of distal tibial fracture during Jan 2001 to Feb 2010.Treated with three approaches as external surgical approach open reduction internal fixation（ORIF） and internal surgical approach by minimally invasive percutaneous plate osteosynthesis（MIPPO）,with finite section internal fixation assisted external fixation in fixed frame.Results All patients were followed up from eight months to four years（an average of 17 months）.The outcome according to the AOFAS＇s score system showed no significant difference（P0.05） in complication rate and good to excellent functional recovery rate,the clinical fracture union and recover working time for patients,intra-operative and post-operation on blood loss.But operating time for MIPPO obviously longer then others the results were significant different（P0.05）.Conclusion According to different pathological type,different operation methods were selected is the key point to get satisfactory curative effect and effectually avoid the complication.To explore retrospectively the techniques of finite section internal fixation assisted external fixation in fixed frame for the treatment of serious distal tibial fractures the outcomes of the treatment.The treatment for ORIF can accept as the best operation way for low-energy impaired persons.MIPPO especially fit for metaphysis comminuted fracture of joint surface.