微创经皮接骨术与带锁髓内钉术治疗胫骨远端骨折的疗效比较

Clinical effect of minimally invasive percutaneous osteosynthesis and intramedullary interlocking nail in the treatment of distal tibial fracture

目的比较微创经皮接骨术(MIPO)与带锁髓内钉(IIN)术治疗简单型胫骨远端骨折的临床疗效。方法本研究为单中心的前瞻性随机对照研究,纳入福建省晋江市医院骨科2012年1月至2014年12月60例胫骨远端骨折的患者,随机分为MIPO组(n=30)及IIN组(n=30)。术中主要评估指标包括:手术时间、术中X线透视时间。术后随访应用X线评估骨折愈合时间、畸形愈合、延迟愈合及并发症情况,应用美国足踝外科协会(AOFAS)踝后足评分系统进行功能评估。结果 60例患者均获得随访,随访12~22(18±5)个月。有20例为开放性骨折,MIPO组11例,IIN组9例。MIPO组手术时间59~196(115±46) min,IIN组手术时间42~188(100±37) min,差异无统计学意义(P> 0. 05)。MIPO组术中X线透视时间为7~81(42±20) s,IIN组为6~54(22±14) s,差异有统计学意义(P <0. 01)。MIPO组愈合时间为10~28(17. 5±5)周,IIN组为11~26(17. 6±4)周,两组差异无统计学意义(P> 0. 05);两组均未发生畸形愈合,两组均有2例发生延迟愈合。MIPO组2例、IIN组1例发生感染,均使用抗生素治愈。AOFAS评分方面,MIPO组得分为66~98(79. 5±9)分,IIN组得分为66~94(80. 7±7)分,两组差异无统计学意义(P> 0. 05)。结论 MIPO技术及IIN技术治疗胫骨远端简单型骨折均能够获得良好地骨折愈合率,均能获得良好的踝关节功能恢复,两种术式均不会增加感染率,也不会影响伤口愈合,两者均为安全、有效的方法。

Objective To investigate the clinical effect of minimally invasive percutaneous osteosynthesis（MIPO） and intramedullary interlocking nail（IIN） in the treatment of distal tibial fracture. Methods This study was a single center prospective randomized controlled trial. A total of 60 patients with distal tibial fracture who received treatment at Jinjiang Municipal Hospital was selected and divided into MIPO group and INN group randomly（n = 30,each）. The main intraoperative indicator included operation time and intra-operative X-ray time. X-ray was used to evaluate the fracture healing time,malformation,delayed union and complications at post-operative follow-up,and the American Orthopaedic Foot and Ankle Society（AOFAS） ankle-hindfoot score was used to assess the function. Results All the 60 patients were followed up for 12-22（18 ± 5） months and there were 20 cases of open fractures（11 cases in MIPO group and 9 cases in INN group）. There was no significant difference in operation time between MIPO group and IIN group [59-196（115 ± 46） min vs 42-188（100 ± 37） min,P〈0. 05]. The intra-operative X-ray time in MIPO group was significant longer than that in INN group [7-81（42 ± 20） s vs 6-54（22 ± 14） s,P〈0. 01]. There was no significant difference in fracture healing time between MIPO group and IIN group [10-28（17. 5 ± 5） weeks vs 11-26（17. 6 ± 4） weeks,P〈0. 05]. There was no malformation in neither group,and there were 2 cases of delayed union in both group. There were 2 cases of infection in MIPO group and 1 case in IIN group,and all of them were cured by antibiotics. There was no significant difference in AOFAS socre between MIPO group and IIN group [66-98（79. 5 ± 9） vs 66-94（80. 7 ± 7）,P〈0. 05]. Conclusion Both MIPO and IIN is a safe and effective treatment for distal tibial fracture,which could achieve a good fracture healing rate and a well ankle function recovery without increasing infection rate and affecting wound healing.