微创经皮钢板内固定与传统切开复位钢板内固定治疗胫骨远端骨折的临床对比研究

Clinical comparative study of minimally invasive percutaneous plate osteosynthesis and traditional open reduction and plate internal fixation on treating distal tibial fracture

目的探讨微创经皮钢板内固定(MIPPO)与传统切开复位钢板内固定治疗胫骨远端骨折的优缺点,以期为胫骨远端骨折手术方式的选择提供参考依据。方法选取80例胫骨远端骨折患者,用随机数字表法将其分为MIPPO组与切开复位组,每组各40例,MIPPO组患者采用MIPPO治疗,切开复位组患者采用传统切开复位钢板内固定治疗,内固定材料均采用锁定钢板,比较两组疗效。结果MIPPO组患者手术时间、骨折愈合时间、术中出血量明显少于切开复位组(P<0.05);术后MIPPO组患者失访4例,切开复位组患者失访7例,两组失访率比较差异无显著性(P>0.05),平均随访时间为12.83个月,随访12个月时进行踝关节评分(kofoed),MIPPO组患者疼痛、功能、活动度评分均高于切开复位组(P<0.05),MIPPO组优良率为94.44%(34/36),明显高于切开复位组[87.88%(29/33)](P<0.05);MIPPO组患者并发症发生率为2.5%(1/40),切开复位组为10%(4/40)。结论胫骨远端骨折采取MIPPO治疗效果明显优于传统切开复位内固定术,MIPPO术后有利于患者进行早期关节功能锻炼,并发症少,关节功能恢复好。

Objective To investigate the advantages and disadvantages of the minimally invasive internal fixation （MIPPO） technique and the traditional open reduction and plate internal fixation in order to provide reference evidence for the selection of operation method. Method Selected 80 patients with fracture of tibial distal, divided into MIPPO group and open reduction group, each group 40 cases, MIPPO group used the M1PPO and internal fixation, open reduction set by traditional open reduction and internal fixation for treatment, both groups used locking plate internal fixation materials, compared the curative effect of two groups. Result Operation time, fracture healing time and intraoperative blood loss of MIPPO group was obviously less than that of open reduction group （P 〈 0.05）, fracture healing time, clinical healing time shorter than the open reduction group （P 〈 0.05）. There were 4 eases lost in MIPPO group while 7 cases in open reduction group, lost to follow- up rate was similar of the two groups had no statistical significance （P 〉 0.05）, the average follow-up time was 12.83 months. Doing kofoed rating after 12 months, patients in MIPPO group with pain, function, activity score were higher than that in open reduction group （P 〈 0.05）, evaluating the effect of treatment of MIPPO group was 94.44% （34/36）, the open reduction group was 87.88% （29/33）, MIPPO group significantly higher than that of open reduction group （P 〈 0.05）; MIPPO group complication rate was 2.5% （1/40） while the open reduction group complications was 10% （4/40）. Conclusion The distal tibial fractures treated with MIPPO technology curative effect is more superior than traditional open reduction and internal fixation, MIPPO is benefit for early postoperative joint functional exercise, it has relatively few complications, better joint function recovery, treatment of distal tibial fracture due to the traditional incision reduction and internal fixation.