微创经皮内固定治疗胫骨骨折的疗效及对肢体功能的影响

Comparative analysis of the effects of minimally invasive percutaneous internal fixation and traditional incision and internal fixation on the efficacy and limb function of patients with tibiofibular fracture

目的探讨分析微创经皮接骨板内固定、传统切开复位内固定和交锁髓内钉内固定对胫骨骨折患者疗效及肢体功能影响的差异性。方法回顾性分析130例于2016年1月至2018年1月期间在洪湖市人民医院住院手术治疗的胫骨骨折患者的临床资料,根据手术方式的不同将其分为微创经皮组(n=52)、传统切开组(n=48)及交锁髓内钉组(n=30)。其中微创经皮组采取微创经皮接骨板内固定技术治疗,传统切开组采用传统切开内固定技术治疗,交锁髓内钉组采用交锁髓内钉技术治疗。比较三组的手术切口长度、手术时间、术中出血量、住院天数、骨折愈合时间以及骨折不愈合、皮下血肿等并发症的发生率,并采用Johner-Wruhs评分评价患者的肢体功能,及踝关节评分Kofoed评分评价患者术后疼痛、功能及活动度情况。结果微创经皮组的手术切口长度、手术时间、术中出血量、住院天数、骨折临床愈合时间均明显优于传统切开组与交锁髓内钉组,差异具有统计学意义(P <0. 05)。术后1年微创经皮组的JohnerWruhs评分优良率明显高于传统切开组与交锁髓内钉组,差异具有统计学意义(P <0. 05);微创经皮组的各Kofoed评分明显高于传统切开组与交锁髓内钉组,差异具有统计学意义(P <0. 05)。微创经皮组的并发症发生率明显低于传统切开组与交锁髓内钉组,差异具有统计学意义(P <0. 05);传统切开组与交锁髓内钉组各指标比较无显著差异性(P>0. 05)。结论微创经皮接骨板内固定术相比于传统切开内固定术及交锁髓内钉技术,切口小,手术时间短,术中出血量少,术后恢复快,骨折愈合时间短,并发症发生率低,且更有利于肢体功能及踝关节功能恢复,值得在临床上推广应用。

Objective To investigate the difference between the effect of minimally invasive percutaneous plate fixation and traditional incision and internal fixation on the effect and limb function of patients with tibiofibular fracture. Methods The clinical data of 130 patients with tibiofibular fractures who were hospitalized in our hospital from January 2016 to January 2018 were retrospectively analyzed. According to different surgical methods,they were divided into minimally invasive percutaneous group( n = 52). The conventional incision group( n = 48) and the interlocking intramedullary nail group( n = 30). The minimally invasive percutaneous group was treated with minimally invasive percutaneous plate fixation. The traditional incision group was treated with traditional incision and internal fixation. The interlocking intramedullary nail group was treated with interlocking intramedullary nail. The length of surgical incision,operation time,intraoperative blood loss,length of hospital stay,fracture healing time,fracture nonunion,subcutaneous hematoma and other complications were compared. The Johner-Wruhs score was used to evaluate the limb function of the patient. The joint score Kofoed score was used to evaluate postoperative pain,function,and mobility. Results The length of surgical incision,operation time,intraoperative blood loss,hospital stay and clinical healing time of the minimally invasive percutaneous group were significantly better than those of the traditional incision group and the interlocking intramedullary nail group. The difference was statistically significant( P < 0. 05). The excellent rate of Johner-Wruhs score in the minimally invasive percutaneous group was significantly higher than that in the conventional incision group and the interlocking intramedullary nail group( P < 0. 05). The Kofoed scores of the minimally invasive percutaneous group were significantly higher than those of the conventional incision group and the interlocking intramedullary nail group( P < 0. 05).There was no significant difference between the traditional incision group and the interlocking intramedullary nail group( P > 0. 05). The incidence of complications in the minimally invasive percutaneous group was significantly lower than that in the conventional incision group and the interlocking intramedullary nail group( P < 0. 05). There was no significant difference between the traditional incision group and the interlocking intramedullary nail group( P > 0. 05). Conclusion Compared with conventional incision and internal fixation with interlocking intramedullary nailing technique,minimally invasive percutaneous plate fixation has a small incision,short operation time,less intraoperative blood loss,quick recovery after operation,and short fracture healing time. The incidence of complications is low,and it is more conducive to limb function and recovery of ankle function. It is worthy of clinical application.