微创经皮钢板内固定技术结合锁定钢板与闭合复位交锁髓内钉治疗胫腓骨骨折疗效分析

Curative analysis of MIPPO technology combined with locking plate and closed reduction technology with interlocking intramedullary nail for tibial and fibula shaft fractures

目的探讨微创经皮钢板内固定（MIPPO）技术结合锁定钢板与闭合复位交锁髓内钉内固定治疗胫腓骨骨折的临床疗效及并发症。方法选择2007年6月至2012年4月治疗的85例胫腓骨骨折患者。将患者分为MIPPO技术结合锁定钢板治疗组（锁定钢板组）40例，闭合复位交锁髓内钉内固定组（髓内钉组）45例。记录两组手术时间、出血量、并发症、下地时间、骨折愈合时间、膝关节功能美国组约特种外科医院（HSS）评分。结果85侧患者均获得随访，随访时间13—40个月。髓内钉组手术时间、出血量均低于锁定钢板组，差异有统计学意义（P〈0．05）。锁定钢板组有1例感染，1例延迟愈合，1例畸形愈合；髓内钉组1例感染，2例延迟愈合，1例不愈合，两组在并发症发生率、完全负重下地行走时间、1年膝关节HSS评分方面比较，差异均无统计学意义（P〉0.05）。结论采用MIPPO技术结合锁定钢板治疗胫腓骨骨折较交锁髓内钉方法手术创伤更小，出血量更少，手术时间更短。严格掌握适应证和手术技巧，二者均是治疗胫腓骨骨折的理想方式。

Objective To explore the clinical effects and complications of minimally invasive percutaneous plate os- teosynthesis （MIPPO） technology combined with locking plate and closed reduction technology with interlocking intramedullary nail for tibial and fibula shaft fractures. Methods A total of 85 patients with tibial and fibula shaft fractures,who underwent treatment from June 2007 to April 2012, were selected, and divided into the group treated with MIPPO technology combined with locking plate （locking plate group, n=40 ） and the group treated with closed reduction with interlocking intramedullary nail （in- tramedullary nail group, n=45 ）. The operation time, intra-operative blood loss, postoperative complications, time of leaving bed, time of bone union, and the Hospital for Special Surgery （HSS） score of the knee function in the two groups were recorded. Results All of the 85 patients were followed up for 13-40 months. The time of operation and intra-operative blood loss in locking plate group were lower than those in interlocking intramedullary nail group with statistically significant difference （P〈0.05）. In the locking plate group, 1 patient got infection, the fracture in 1 patient was delayed union, and 1 patient was malunion. In interlocking in- tramedullary nail group, 1 patient was infectious, the fracture in 2 patients was delayed union and 1 patient was nonunion. The dif- ference between the two groups on occurrence rate of complications ,time of walking with load completely and 1-year HSS scores of the knee was statistically significant （P〉0.05）. Conclusion The application of MIPPO combined with locking plate has small- er operative wound ,less amount of bleeding and shorter time of operation than closed reduction technology with interlocking in- tramedullary nail for tibial and fibula shaft fractures. The indications and the operation skills should be strictly mastered, and both of the technologies are an ideal way to treat fracture of tibia and fibula.