两种微创手术治疗胫骨下段骨折的临床对比研究

Two minimally invasive surgeries for treatment of distal tibial fracture: a clinical comparative study

[目的]对比研究专家型胫骨髓内钉内固定和锁定接骨板内固定微创治疗胫骨下段骨折的临床疗效。[方法]本院自2012年1月-2015年1月收治59例胫骨下段患者,随机分为专家型胫骨髓内钉内固定微创治疗组（髓内钉组）和锁定接骨板内固定微创治疗组（MIPO组）,对骨折治疗过程、愈合情况、功能进行评估。[结果]待手术时间（5.2±1.4 VS 6.4±2.3）d、出血量（62.4±25.3 VS 98.5±28.1）ml,髓内钉组优于MIPO组（P〈0.05）。透视次数MIPO组优于髓内钉组[（8±2 VS 15±8）次,P〈0.05]。所有患者得到有效随访,时间为12-24个月,髓内钉组骨折临床愈合时间（17±3）周,MIPO组骨折临床愈合时间（17.5±5）周。两组手术时间、最后的Johner-Wrushs评级差异无统计学意义（P〉0.05）。[结论]闭合或小切口复位髓内钉固定、闭合或小切口复位胫骨远端内侧锁定接骨板固定是治疗胫骨下段骨折两种有效的治疗方法,医生应根据患者、科室具体条件及自身熟练情况选用。

[ Objective ] To investigate the clinical effect of internal fixation with expert intramedullary nail or locking plate as the minimally invasive surgery in the treatment of distal tibial fracture. [ Method] A total of 59 patients with distal tibial frac- ture who were admitted to our hospital from January 2012 to January 2015 were enrolled and randomly divided into expert intr- amedullary nail internal fixation group （ intramedullary nail group） and locking plate internal fixation group （ MIPO group）. The process of the treatment of fracture, healing status, and tibial function were evaluated. [ Result] The intramedullary nail group had significantly higher time of operation and blood loss than the MIPO group （ time of operation ：5.2 ± 1.4 d vs 6.4 ± 2.3 d, P 〈 0.05 ; blood loss ：80.2 ± 62.7 ml vs 201.6 ± 130.8 ml, P 〈 0.05 ）. The M IPO group had a significantly lower number of times of intra - operative fluoroscopy （ 8 ± 2 vs 15 ± 8 times, P 〈 0.05 ）. All the patients were effectively followed up for 12 - 24 months. The clinical fracture healing time was 17 ± 3 weeks in the intramedullary nail group and 17.5 ± 5 weeks in the MIPO group. The time of operation and final Johner - Wrushs grade showed no significant differences between the two groups （P 〉 0. 05 ）. [ Conclusion] Closed or small - incision internal fixation with intramedullary nail and closed or small - incision internal fixa- tion with distal medial tibial locking plate are two effective methods for the treatment of distal tibial fracture. Physicians should de- cide which one to use based on the actual conditions of patients and the department, as well as his/her own proficiency.