微创经皮锁定钢板固定与髓内钉固定治疗胫骨干骨折的隐性失血量对比

Comparison of hidden blood loss between minimally invasive percutaneous locking plate fixation and intramedullary nail fixation in the treatment of tibial shaft fracture

目的:分析比较微创经皮钢板固定技术(minimally invasive percutaneous plate osteosynthesis,MIPPO)技术联合锁定钢板固定与髓内钉固定治疗胫骨干骨折的隐性失血量。方法:回顾分析2017年1月至2019年1月治疗的191例胫骨干骨折患者,患者均采用闭合复位,分为A、B两组,A组110例,B组81例。A组采用MIPPO技术联合锁定钢板治疗,男78例,女32例;年龄19~74(45.32±11.79)岁;骨折按照AO分型:42-A型42例,42-B型45例,42-C型23例。B组采用髓内钉治疗,男65例,女16例,年龄19~84(45.44±14.32)岁。骨折按照AO分型:42-A型39例,42-B型29例,42-C型13例。观察比较两组患者手术时间、术中失血量及隐性失血量。结果:第1天隐性失血量:A组(155.27±47.89)ml,B组(160.43±131.42)ml,差异有统计学意义(P<0.001);第3天隐性失血量:A组(102.70±94.79)ml,B组(338.23±85.24)ml,差异有统计学意义(P<0.001)。两组在性别、年龄、身高、体重、骨折类型及术前红细胞比容(hematocrit value,Hct)之间无统计学意义(P>0.05)。结论:髓内钉治疗胫骨干骨折存在明显的隐性失血,远高于预期。

Objective:To analyze and compare the hidden blood loss of minimally invasive percutaneous plate osteosynthesis(MIPPO)combined with locking plate fixation and intramedullary nail fixation in the treatment of tibial shaft fracture.Methods:One hundred and ninety one cases of tibial shaft fracture treated from January 2017 to January 2019 were analyzed retrospectively.The patients were all treated with closed reduction and divided into two groups:group A(110 cases)and group B(81 cases).In group A,78 males and 32 females were treated with MIPPO combined with locking plate.The age ranged from19 to 74(45.32±11.79)years old.According to AO classification,42 cases were type 42-A,45 were type 42-B and 23 were type 42-C fractures.Group B was treated with intramedullary nail,including 65 males and 16 females,aged 19 to 84(45.44±14.32)years old.According to AO classification,there were 39 cases of type 42-A,29 cases of type 42-B and 13 cases of type42-C.The operation time,intraoperative blood loss and hidden blood loss were observed and compared between the two groups.Results:On the first day,the hidden blood loss was(155.27±47.89)ml in group A and(160.43±131.42)ml in group B,the difference was statistically significant(P<0.001);on the third day,the hidden blood loss was(102.70±94.79)ml in group A and(338.23±85.24)ml in group B,the difference was statistically significant(P<0.001).There was no significant difference between the two groups in gender,age,height,weight,fracture type and preoperative Hct(P>0.05).Conclusion:In the treatment of tibial shaft fracture with intramedullary nail,there is obvious hidden blood loss,which is much higher than expected.