经皮微创钢板内固定与传统术式治疗胫骨平台骨折疗效和膝关节功能的比较研究

Comparison of efficacy and knee joint function between mininmally invasive percutaneous plate osteosynthesis and conventional surgery in treatments of fracture of tibia plateau

目的探讨比较经皮微创钢板内固定手术(MIPPO)与常规手术治疗胫骨平台骨折疗效及对患者膝关节功能的影响。方法回顾性分析95例行手术治疗的胫骨平台骨折患者的临床资料,按手术方式分为常规组(n=39)和微创组(n=56)。常规组给予切开复位内固定术,微创组给予MIPPO,比较两组手术情况、并发症、膝关节活动度及膝关节功能等情况。结果所有患者均手术成功。与常规组比较,微创组切口长度减小,住院时间及切口愈合时间缩短[(3.9±1.3)vs(8.6±1.8)cm,(10.3±2.2)vs(14.2±2.8)d,(11.3±2.6)vs(14.6±2.4)周],均差异有统计学意义(P<0.05),而手术时间两组间比较差异无统计学意义(P>0.05)。术后,常规组和微创组的并发症发生率分别为12.82%和1.78%,组间比较差异无统计学意义(P>0.05)。术后6个月,微创组伸膝和屈膝最大角度均大于常规组,(-0.64±0.16)°vs(-0.36±0.10)°,(130.57±7.34)°vs(114.77±6.81)°,两组比较差异有统计学意义(P<0.05)。两组患者随访1年,常规组的优良率为82.1%,微创组的优良率为96.4%,比较差异有统计学意义(P<0.05),微创组的优良率高于常规组。结论 MIPPO是胫骨平台骨折的有效手术方式,创伤小,术后恢复快,膝关节功能改善显著,膝关节功能恢复状况优于常规的切口复位内固定治疗,但并发症发生率差异无统计学意义,临床上值得进一步研究。

Objective To compare the efficacy and knee joint function between mininmally invasive percutaneous plate osteosynthesis(MIPPO) and conventional surgery in treatment of fracture of tibia plateau. Methods Ninety-five cases with fracture of tibia plateau that were given surgical treatment were selected as research subjects and their clinical materials were retrospectively analyzed. Then, these cases were divided into convention group(n = 39) and minimally invasive group(n = 56) according to the operation type. The convention group was given open reduction and internal fixation, while the minimally invasive group was given MIPPO. Operation situation, incidences of complications, ranges of motion and knee joint functions of the two groups were compared. Results All patients underwent successful operation. In comparison with the convention group, the minimally invasive group had a statistically shorter incision [(3.9 ± 1.3) vs(8.6 ± 1.8) cm], shorter hospitalization time [(10.3 ± 2.2) vs(14.2 ± 2.8) d]and healing time [(11.3 ± 2.6) vs(14.6 ± 2.4) w](all P < 0.05), while the operation time between the two groups was not statistically different(P > 0.05). After operation, the incidence of complications was 1.78% in the minimally invasive group and 12.82% in the convention group with statistical difference(P < 0.05). Six months after operation,the minimally invasive group had bigger maximal knee extension and crouch angles than the convention group[(-0.64 ± 0.16)° vs(-0.36 ± 0.10)°,(130.57 ± 7.34)° vs(114.77 ± 6.81)° respectively, P < 0.05]. After one-year follow-up, the minimally invasive group had an excellent and good rate of 96.4%, which was statistically higher than that of 82.1% in the convention group(P < 0.05). Conclusions MIPPO is an effective operation method for fracture of tibia plateau, and has advantages of little trauma, fast recovery after operation, much improved function of knee joint. But its complication rate is not different from open reduction and internal fixation. MIPPO should be further studied in future.