经皮锁定钢板与传统解剖钢板内固定治疗胫骨下段骨折的比较

Percutaneous locking plate versus traditional anatomical plate fixation for distal tibial fracture

背景:微创接骨板桥接技术的特点是间接骨折闭合复位,辅以适当稳定的内固定,可最大程度地保护骨折端及其周围的血供,为骨折愈合提供良好的生物环境,在长骨干骨折治疗中具有良好疗效。目的:比较微创经皮锁定钢板与传统解剖钢板置入内固定治疗胫骨下段骨折的临床疗效。方法:选择胫骨下段闭合骨折患者68例,其中男38例,女30例;年龄15-68岁。根据患者入院顺序和随机排列表分两组治疗,微创组(n=32)在C型臂X射线机监视下采用经皮锁定钢板内固定置入治疗,传统组(n=36)采用普通胫骨加压钢板及有限接触动力加压钢板置入内固定治疗。比较两组临床疗效。结果与结论:微创组手术时间、骨痂形成时间、骨折愈合时间、恢复负重行走时间早于传统组(P<0.05),术中出血少于传统组(P<0.05)。随访10-21个月,微创组肢体功能恢复优良率为97%,传统组肢体功能恢复优良率为81%,两组优良率比较差异有显著性意义(P<0.05)。结果表明微创经皮锁定钢板内固定符合生物学及力学原则,具有创伤小、切口及软组织并发症少、利于骨折愈合等优势,是治疗胫骨下段骨折的有效方法。

BACKGROUND：Minimal y invasive percutaneous plate osteosynthesis is characterized by indirect closed reduction of fracture, supplemented by suitable stable internal fixation, can protect blood supply in the fracture end and surrounding to the maximum, provide good biological environment, and have good curative effects on treatment of long bone shaft fracture. OBJECTIVE：To compare the clinical curative effects of minimal y invasive percutaneous locking plate versus traditional anatomical plate fixation for distal tibial fracture. METHODS：A total of 68 patients with closed fracture of distal tibia, including 38 males and 30 females, aged 15-68 years old, were selected. In accordance with admission order and random ranked list, the patients were assigned to two groups. Minimal invasion group （n=32） received percutaneous locking plate fixation under the monitoring of C-arm X-ray machine. Traditional group （n=36） received common tibia compression plate and limited contact-dynamic compress plate fixation. The clinical curative effects were compared between the two groups. RESULTS AND CONCLUSION：Operation time, cal us formation time, fracture union time, and time of restoring weight-bearing walking in the minimal invasion group were earlier compared with traditional group （P〈0.05）, but intraoperative hemorrhage was less in the minimal invasion group than the traditional group （P〈0.05）. After fol ow-up for 10-21 months, the excellent and good rate of limb function recovery was 97%in the minimal invasion group and 81%in the traditional group. Significant differences in the excellent and good rate were detectable between minimal invasion and traditional groups （P〈0.05）. Results suggested that minimal y invasive percutaneous locking plate fixation was in accorded with biological and mechanical principles, had less trauma, few complications in the incision and soft tissue, promoted fracture healing, and was an effective method to treat distal tibial fracture.