两种方法内固定治疗胫骨下段骨折疗效比较

Efficacy comparison of two kinds of methods in the treatment of distal tibial fracture

目的比较微创经皮钢板接骨术(MIPPO)结合锁定加压钢板(LCP)与切开复位解剖型钢板内固定(ORIF)治疗胫骨下段骨折的疗效。方法将163例胫骨下段骨折患者按治疗方法分为两组,其中观察组(87例)采用MIPPO结合LCP治疗,对照组(76例)采用ORIF治疗。比较两组术中出血量、手术时间、住院时间、下地负重时间、去拐时间、骨折临床愈合时间及术后并发症情况,末次随访评价两组关节功能Johner-Wruhs评分优良率。结果患者均获得随访,时间6~12个月。观察组术中出血量、住院时间、下地负重时间、去拐时间、骨折临床愈合时间均少于对照组(P<0.05),但手术时间长于对照组(P<0.05)。观察组术后未发生严重并发症,对照组并发症发生率为10.5%,差异有统计学意义(P<0.05)。观察组末次随访关节功能JohnerWruhs评分优良率为95.4%,明显高于对照组的78.9%(P<0.05)。结论 MIPPO结合LCP治疗胫骨下段骨折可有效保护骨折端血供,获得满意功能恢复效果,并减少术后并发症的发生。

Objective To compare the efficacy of minimally invasive percutaneous plate osteosynthesis(MIPPO)combined with locking compression plate(LCP)and open reduction anatomic plate internal fixation(ORIF)for treatment of distal tibial fracture.Methods The 163 cases with distal tibial fractures were divided into two groups,according the treatment methods,of which 87 cases underwent MIPPO combined with LCP(the observation group),and 76 cases underwent ORIF(the control group).The intraoperative bleeding volume,surgery time,length of hospital stay,down load and weight-bearing time,without crutch time,fracture clinical healing time and complications of two groups were compared.At the last follow-up,the excellent-good rate of joint function Johner-Wruhs scores in the two groups were evaluated.Results All the patients were followed up for 6~12 months.The observation group of intraoperative bleeding volume,length of stay,down load and weight-bearing time,without crutch time,and fracture clinical healing time were shorter than those of the control group(P<0.05),while surgery time in observation group was longer than that of control group(P<0.05).There was no serious complication in the observation group,and the complications incidence rate of the control group was 10.5%,there was statistical significance(P<0.05).At the last follow-up,the excellence-good rate of Johner-Wruhs scores in the observation group(95.4%)was significantly higher than 78.9%of the control group(P<0.05).Conclusions MIPPO combined with LCP for treating distal tibial fracture not only can effectively protect blood supply of the fracture ends and achieve the satisfactory function recovery effect,but also can reduce the complications incidence after operation.