三种不同内固定方式治疗胫骨中下段骨折疗效比较

Comparison of three different internal fixation methods for middle and lower tibia fractures

目的比较解剖型胫骨髓内钉(ETN)、微创经皮钢板内固定(MIPPO)、切开复位有限接触钢板(LC-DCP)内固定三种方式治疗胫骨中下段骨折的疗效。方法回顾分析2013年5月—2018年5月在广东医科大学附属第三医院采用内固定手术治疗的胫骨中下段骨折患者96例(男性67例,女性29例;年龄19～72岁,平均39.8岁)。32例采用ETN,28例采用MIPPO,36例采用LC-DCP。致伤机制:道路交通伤45例,高处坠落伤11例,摔伤26例,砸伤14例。比较三组手术时间、失血量、骨折愈合情况、并发症以及术后6个月Johner-Wruhs评分。结果 MIPPO组虽然手术时间最长(114.14min),但失血量(65.00mL)较ETN组(121.56mL)和LC-DCP组(196.11mL)少;透视检查方面三组差异有统计学意义(LC-DCP组7.27s,ETN组14.16s,MIPPO组22.96s)。在术后评估方面,ETN组及MIPPO组开始负重时间、骨折愈合时间、Johner-Wruhs评分均优于LC-DCP组。LC-DCP组的并发症发生率高于其他两组,差异有统计学意义(P<0.01)。结论 ETN和MIPPO是治疗胫骨中下段骨折的有效方法,与LC-DCP相比,具有更好的治疗效果。

Objective To compare the efficiency of expert tibial nail(ETN),minimally invasive percutaneous plate osteosynthesis(MIPPO) and limited contact dynamic compression plate(LC-DCP) for treating middle and distal tibial fracture. Methods A total of 96 patients who suffered from middle and distal tibial fracture and received surgery treatment in our department from May,2013 to May,2018 were retrospectively studied,including 67 males and 29 females with a mean age of 39.8 years(ranging from 19 to 72 years). Among the patients,32 patients were treated with ETN,28 patients with MIPPO and 36 patients with LC-DCP. Traffic accident injury(45 patients),high falling injury(11 patients),tumbling(26 patients) and crushing(14 patients) were the causes of fracture. The operation process,post-operative fracture healing,complication and Johner-Wruhs score were compared among the three groups. Results Although the longest operation time(114.14 min) was present in the MIPPO group,this group had much less blood loss(65 mL) than ETN group(121.56 mL) and LC-DCP group(196.11 mL). Fluoroscopy showed significant differences among the three groups(7.27 seconds in LC-DCP group,14.16 seconds in ETN group and 22.96 seconds in MIPPO group). In regard to the post-operative assessment,the time of weight-bearing activity and facture healing as well as the Johner-Wruhs scores were superior in ETN group and MIPPO group than in LC-DCP group. More complications occurred in LC-DCP group than the other two groups(P<0.01). Conclusion ETN and MIPPO are effective treatment options for middle and distal tibial fracture,which lead to a better efficiency than LC-DCP.