胫骨多向锁定髓内针与胫骨远端钢板治疗胫骨远端骨折的疗效比较

Clinical efficacy of tibial multidirectional interlocking intramedullary nail versus minimally invasive percutaneous plate osteosynthesis in treatment of distal tibial fractures

[目的]比较分析胫骨多向锁定带锁髓内针（TTMLIIN）与经皮微创胫骨远端钢板固定（MIPPO）治疗胫骨远端骨折的临床疗效。[方法]回顾性分析本院2010年11月~2014年12月收治的胫骨远端骨折患者45例,根据AO骨折分型标准：43A型21例,43B型12例,43C型8例。23例采取胫骨多向锁定带锁髓内针固定,其中3例为Ⅱ度以上开放性骨折;18例采用经皮微创胫骨远端钢板固定,其中9例为Ⅱ度以上开放性骨折。术后进行临床随访,采用门诊定期预约随访的方法,对患者的功能恢复和并发症发生情况等进行随访和记录。观察两组手术相关情况,包括手术时间和术中出血量以及骨折愈合时间与完全负重时间。应用Johner-Wruhs胫骨骨折评分系统评价患肢功能,并进行膝关节HSS评分和踝关节AOFAS评分。观察两组的并发症发生情况。[结果]MIPO组的手术时间显著长于TMLIIN组,术中出血量显著大于TMLIIN组（P〈0.05）。但两组骨折愈合时间与完全负重时间比较差异均无统计学意义（P〉0.05）。经Johner-Wruhs评分系统评价患肢功能,MIPO组：优9例,良6例,可1例,差2例。TMLIIN组：优17例,良6例,可0例,差0例,两组比较差异无统计学意义（P〉0.05）。术后12个月,两组膝关节HSS评分和踝关节AOFAS评分比较差异无统计学意义（P〉0.05）。术后MIPO组有2例皮肤坏死,1例伤口感染,1例骨折不愈合,1例骨折延迟愈合;TMLIIN组有1例水泡结痂后皮肤破溃坏死骨外露,两组患者并发症发生率比较差异有统计学意义,MIPO组显著高于TMLIIN组,P〈0.05。[结论]胫骨远端骨折实施胫骨多向锁定带锁髓内针与胫骨远端钢板治疗均能够获得理想的固定和骨折愈合效果,经皮微创胫骨远端钢板固定的并发症相对较少。

[ Objective ] To compare and analyze the clinical efficacy of tibial multidirectional interlocking intramedullary nail（TMLIIN） and minimally invasive percutaneous plate osteosynthesis （MIPPO） in the treatment of distal tibial fractures. [ Method] A total of 45 patients with distal tibial fracture who were admitted to our hospital from November 2010 to December 2014 were retrospectively analyzed. The numbers of 43A, 43B, and 43C cases were 21, 12, and 8, respectively, based on AO classification of fractures. Twenty - three patients were treated with TMLIIN, with 3 cases being grade II open fractures or more severe, 18 patients were treated with MIPPO, with 9 cases being grade II open fractures or more severe. The patients were fol- lowed up regularly by outpatient appointment to record function recovery and complications. The operation time, bleeding during operation, fracture healing time, and time to full weight bearing were observed. The function of the injured limb was evaluated with the Johner - Wruhs tibial fracture scoring system, and the knee joint and ankle joint were evaluated with Hospital for Spe- cial Surgery （HSS） knee scoring system and American Orthopedic Foot ＆ Ankle Society （AOFAS） ankle scoring system, re- spectively. The complications of the two groups were also observed. [ Result]The MIPPO group had significantly longer operation time and larger volume of bleeding during operation than the TMLIIN group （P 〈 0.05）. According to Johner - Wruhs scoring system, the numbers of patients showing excellent, good, fair, and poor outcomes were 9, 6, !, and 2, respec- tively, in the MIPPO group, and 17, 6, 0, and 0, respec-tively, in the TMLIIN group, with significant differences between the two groups （all P 〉 0.05 ）. At 12 months after operation, the two groups showed no significant differences in HSS score and AOFAS score （P 〉 0.05）. After operation, the MIPPO group had 2 cases of cutaneous necrosis, 1 case of wound infection, 1 case of nonunion of fracture, and 1 case of delayed union of fracture; the TMLIIN group had 1 case of necrotic bone exposure after blister incrustation and skin rupture. The MIPPO group had a significantly higher incidence of complications than the TLMIIN group （ P 〈 0.05 ）. [ Conclusion ] Both TLMIIN and MIPPO can achieve satisfactory fixation and healing effects and can improve patients＇joint function in the treatment of distal tibi- al fractures. However, MIPPO causes fewer complications than TLMIIN.