损伤早期与延期微创经皮钢板接骨术治疗AO/ASIF-43 A3型胫骨远端骨折的临床对比研究

Early and delayed primary minimally invasive percutaneous plate osteosynthesis for treatment of AO/ASIF 43.type A3 distal tibial fractures:a clinically controlled study

目的比较损伤早期与延期微创经皮钢板接骨术(minimally invasive percutaneous plate osteosynthesis,MIPPO)技术治疗AO/ASIF-43A3型胫骨远端骨折的临床疗效。方法回顾分析2010年2月至2016年2月AO/ASIF-43 A3型胫骨远端骨62例患者临床资料。根据手术时机,将患者分为两组,A组31例,在损伤早期即实施MIPPO手术,B组31例,择期接受MIPPO手术。比较两组患者手术时间、伤口并发症、术中出血量、住院时间、骨折愈合时间及Lowa踝关节评分。结果两组患者的平均手术时间、术中出血量差异无统计学意义(P>0.05),但A组的住院时间显著短于B组(P<0.05)。A组与B组的平均骨折愈合时间、末次随访Lowa踝关节评分组间差异无统计学意义(P>0.05)。A组中2例(6.4%)术后发生腓骨切口周围浅表炎症反应;B组中1例(3.2%)患者胫骨切口周围浅表炎症反应,1例(3.2%)在术后4个月时发生切口深部迟发性感染。两组术后软组织并发症发生率均为6.4%,组间差异无统计学意义(P>0.05)。结论早期和延期MIPPO技术治疗A3型胫骨远端骨折均可获得满意的临床效果,早期MIPPO技术治疗胫骨远端骨折不会增加患者的术后软组织并发症发生率,且能缩短住院时间、节约患者住院期间的治疗费用。

Objective The objective of this study was to compare the clinical efficacy of early and delayed minimally invasive percutaneous plate osteosynthesis(MIPPO)for AO/ASIF-43A3distal tibial fractures.Methods Clinical data of62patients with AO/ASIF-43A3distal tibial bone from February2010to February2016were retrospectively analyzed.According to the timing of operation,patients were divided into two groups:group A(31cases),MIPPO operation was performed at the early stage of injury;group B(31cases),and MIPPO operation was performed at the selected time.The operative time,complications,intraoperative blood loss,time of hospitalization,time of fracture healing and Lowa ankle score were compared between the two groups.Results There was no significant difference in mean operative time and intraoperative blood loss between the two groups(P>0.05).But the time of hospitalization in group A was significantly shorter than that in group B(P<0.05).There was no significant difference in mean fracture healing time and Lowa ankle score between group A and group B(P>0.05).In group A,2cases(6.4%)had superficial inflammatory reaction around fibular incision after operation.In group B,1(3.2%)had superficial inflammation around the tibial incision,and1(3.2%)had delayed deep infection4months after surgery.The incidence of postoperative soft tissue complication in the two groups was6.4%,and there was no significant difference between the two groups(P>0.05).Conclusion Both early and delayed MIPPO techniques can achieve satisfactory clinical results in the treatment of A3type distal tibial fractures.Early MIPPO technique for distal tibial fractures does not increase the incidence of postoperative soft tissue complications,and can shorten the length of stay and save the cost of hospitalization.