经皮微创钢板内固定与切开复位内固定治疗不同分型胫骨远端骨折疗效及指征

Clinical curative effect and indications of minimally invasive percutaneous plate fixation and open reduction and internal fixation in the treatment of different types of distal tibial fractures

目的：探讨经皮微创钢板内固定与切开复位内固定治疗不同分型胫骨远端骨折疗效及指征。方法：回顾性分析我院2006年10月～2010年6月收治的胫骨远端骨折未累及关节面患者80例，将采用闭合复位经皮微创钢板内固定患者36例作为研究组，将采用切开复位内固定患者44例作为对照组，比较两组患者骨折愈合时间、畸形愈合及并发症发生率。结果：研究组手术时间及术中出血量均少于对照组，差异均有统计学意义（均P〈0．05）。全部患者术后平均随访12．5个月，两组A1、A2、B1、B2、B3型骨折愈合时间差异无统计学意义（P〉0．05），研究组A3型骨折愈合时间长于对照组，C1、C2、C3型骨折愈合时间短于对照组，差异均有统计学意义（均P〈0．05）。两组骨不连和畸形愈合发生率比较，差异有统计意义（P〈O．05），两组延迟愈合及切口感染发生率比较，差异无统计学意义（均P〉0．05）。结论：经皮微创钢板内固定术治疗C型胫骨远端骨折效果较好，在对B型及A1、A2型胫骨远端骨折的治疗中疗效较切开复位内固定术无明显优势，并且其对A3型胫骨远端骨折的治疗效果差于切开复位内固定术。

Objective： To discuss the efficacy and indications of minimally invasive percutaneous plate fixation （MIPPO） and open reduction and internal fixation in the treatment of different types of distal tibial fractures. Methods： 80 cases of patients who were diagnosed with distal tibial fractures and no articular surface involved in our hospital from October 2006 to June 2010 were analyzed retrospectively. MIPPO treatment of 36 cases of patients were divided into study group, and open reduction and internal fixation treatment of 44 cases of patients were divided into control group. Fracture healing time, malunion, complication incidence of the two groups were compared. Results： Amount of bleeding loss and operative time of study group were less than those of the control group, the differences were statistically significant （P〈0.05）. All patients were followed up for average of 12.5 months, healing time of A1, A2, B1, B2, B3 type fracture of two groups had no significant difference （P〉O.05）, the healing time of A3 types fracture of study group was longer than that of the control group, and the healing time of C1, C2, C3 types fracture were shorter than those of the control group, the differences were statistically significant （P〈0.05）. Nonunion and malunion incidence of the two groups were significantly different （P〈0.05）, delayed healing and wound infection rate of the two groups had no significant difference （P〉0.05）. Conclusion： Curative efficacy of MIPPO in the treatment of C type of distal tibial fractures is better than open reduction and internal fixation, but in the treatment of B, A1, A2 type of distal tibial fracture, the curative efficacy of the two methods have no significantly different, and curative efficacy of MIPPO in the treatment of A3 type of distal tibial fracture is worse than open reduction.