MIPPO与IMN治疗胫骨远端关节外骨折的疗效及其对血清炎性因子的影响

Clinical effect of MIPPO and IMN in the treatment of distal tibial fracture and its effect on serum inflammatory factors

目的探讨交锁髓内钉(IMN)与微创经皮钢板内固定(MIPPO)技术对胫骨远端关节外骨折的疗效及其对血清炎性因子的影响。方法选取2013年1月至2015年12月来我院进行治疗胫骨远端外关节骨折患者60例,按照随机数字表将其分为IMN组和MIPPO组,每组各30例。比较两组患者主要围术期基本指标,包括术中出血量、手术时长、住院时间和愈合周期;通过Mazur评分系统评价两组患者术后踝关节功能恢复情况;比较两组患者血清炎性因子白介素-1(IL-1)和超敏C-反应蛋白(hs-CRP)水平。结果 IMN组术中出血量和住院时间分别为(83.6±13.5)m L、(17±3)d,MIPPO组分别为(82.5±14.6)m L、(18±2)d,差异均无统计学意义(P>0.05);IMN组手术时长和愈合周期分别为(64.5±7.4)min、(13.65±2.1)周,MIPPO组分别为(58.4±3.5)min、(10.49±1.4)周,差异均有统计学意义(P<0.05)。术后半年IMN组踝关节功能(90.00%)与MIPPO组(93.33%)差异无统计学意义(P>0.05)。治疗后IMN组IL-1和TNF-α水平分别为(79.5±4.9)ng/L、(70.97±0.32)ng/L,MIPPO组分别为(50.5±5.3)ng/L、(53.56±0.19)ng/L,差异均有统计学意义(P<0.05)。结论 MIPPO与IMN治疗胫骨远端关节外骨折疗效相似,但MIPPO可以明显缩短创伤愈合时间,减少炎性反应。

Objective To explore the clinical effect of minimally invasive percutaneous plate osteosynthesis（MIPPO） and intramedullary nail（IMN） in the treatment of distal tibial fracture and its effect on s0 erum inflammatory factors. Methods A total of 60 patients with distal tibial fracture, who admitted to our hospital from Jan. 2013 to Dec.2015, were randomly divided into group IMN and group MIPPO, with 30 cases in each group. The group IMN and MIPPO were respectively treated with IMN and MIPPO. The perioperative basic indexes of the two groups, including intraoperative blood loss, duration of surgery, length of stay and fracture healing, were compared. The functional recovery of the ankle joint in the two groups was evaluated by Mazur score. The serum levels of inflammatory factors interleukin-1（IL-1） and tumor necrosis factor-α（TNF-α） were compared between the two groups. Results There was no significant difference between the two groups in the amount of bleeding（83.6±13.5） m L vs（82.5±14.6） m L and length of stay（17±3） d vs（18±2） d（P〈0.05）. However, the duration of surgery and the healing period in the group IMN were respectively（64.5±7.4） min and（13.65±2.1） weeks, which were significantly longer than（58.4±3.5） min and（10.49±1.4） weeks in the group MIPPO（P〈0.05）. Half a year after the treatment, there was no significant difference in the ankle functions between the two groups（90.00% vs 93.33%, P〈0.05）. After the treatment, the levels of IL-1 and TNF-α in the group IMN were（79.5±4.9） ng/L and（70.97±0.32） ng/L, which were significantly higher than（50.5±5.3） ng/L and（53.56±0.19） ng/L in the group MIPPO（P〈0.05）. Conclusion MIPPO and IMN have the similar efficacy in the treatment of distal tibial fractures, but MIPPO can significantly shorten the healing time and reduce the inflammatory reaction.