小切口钢板内固定治疗胫骨骨折两种置钉方式疗效比较

Comparison of clustered screw insertion and separated screw insertion of minimal invasive plate osteosynthesis in treatment of midshaft tibia fractures

目的探讨微创钢板固定法（MIPO）治疗胫骨骨折中连续置钉与间隔置钉两种固定方式的临床疗效并进行对比。方法采用MIPO技术治疗46例胫骨中段骨折，连续置钉组22例，间隔置钉组24例。术后24h内均不负重状态下功能锻炼。对比分析两组手术时间、术中出血量、完全负重时间、骨折愈合时间及术后Johner-Wruhs评分以及内固定断裂发生率。结果所有患者均获得平均14．8（12-24）个月随访。两组手术时间、术中出血量及末次随访Johner-Wruhs评分的差异均无统计学意义（P〉0．05）。连续置钉组骨折愈合时间与完全负重时间较间隔置钉组延长，内固定断裂发生率更高。结论采用MIPO技术治疗胫骨干骨折时，间隔置钉的固定方法可避免应力过于集中，降低内固定断裂的风险，有利于加快骨折愈合，能使患者早期负重。

Objective To evaluate and compare the clinical effects of clustered screw insertion with separated screw insertion of minimal invasive plate osteosynthesis （MIPO） in the treatment of midshaft tibia fractures. Methods A retrospective study with more than 12 months follow-up of 46 patients with midshaft tibia fractures who underwent MIPO was carried out, including 22 with clustered screw insertion and 24 patients with separated. Operation duration and volume of blood loss were assessed in the two groups, respectively. At the final follow-up, full weight bearing time, fracture healing time, final functional results evaluated according to Johner-Wruhs methods and occurring rate of implantation breakage of each group were statistically analyzed, respectively. Results The average follow-up period was 14.8 months （range, 12-24）. There were no significant differences between cluster group and separate group for the average operating time, the average volume of intraoperative bleeding and the excellent-good rate of Johner-Wruhs score （P 〉0.05）. The fracture healing time and full weight-bearing time in the cluster group were longer than the separate group. The rate of plate and screw broken in the cluster group was higher than the separate group. Conclusion MIPO using locking compression plate （LCP） in the treatment of midshaft tibia fracture,the separated screw insertion could beneficially disperse stress upon the implantation and promote fracture healing. The fracture treated by LCP with separated screws allows earlier weight bearing.