急诊与择期微创手术治疗胫骨干远端骨折的对照研究

Comparative study on emergency and selective minimally invasive surgery for distal tibial shaft fractures

目的比较微创接骨板内固定术(MIPPO)急诊与择期治疗闭合性(AO/OTA)42-A1型胫骨干远端骨折的效果,为急诊手术治疗提供依据。方法回顾性分析2014年11月—2017年10月同济大学附属东方医院创伤骨科基于MIPPO急诊或择期治疗的106例闭合性(AO/OTA)42-A1型胫骨干远端骨折患者的病例资料。2016年5月—2017年10月收治的64例患者均急诊手术(急诊手术组),其中男性38例,女性26例;年龄18~79岁,平均39.2岁。2014年11月—2016年4月收治的42例患者均择期手术(择期手术组),其中男性29例,女性13例;年龄21~85岁,平均40.4岁。患者均随访10个月~4年,平均12.9个月。分析两组患者美国麻醉学会(ASA)病情评分、手术时间、术中出血量、软组织感染率、骨折愈合时间、Johner-Wruhs评分及住院时间。结果急诊手术组与择期手术组患者ASA评分、手术时间、术中出血量、骨折愈合时间、软组织感染率、Johner-Wruhs评分优良率(2.76±0.85)分vs.(2.60±0.82)分、(68.3±23.4)min vs.(79.4±22.1)min、(285.7±73.1)mL vs.(245.8±77.2)mL、(17.3±6.7)周vs.(16.3±5.6)周、12.50%vs.11.90%、95.31%vs.93.65%差异均无统计学意义(P>0.05);急诊手术组平均住院时间(7.5±0.7)d少于择期手术组(10.8±1.2)d,两组比较差异有统计学意义(P<0.05)。结论基于MIPPO技术急诊手术治疗闭合性(AO/OTA)42-A1型胫骨干远端骨折安全有效,并能减少患者的住院时间。

Objective To compare emergency and selective operation based on the minimally invasive percutaneous plate osteosynthesis(MIPPO)for closed AO/OTA type 42-A1 distal tibial shaft fracture to provide evidence for emergency operation.Methods A retrospective analysis was performed in 106 patients with closed distal tibial shaft fractures treated with emergency or selective operation based on MIPPO technique from Nov.2014 to Oct.20l7.Totally 64 cases were treated with emergency operation from May.2016 to Oct.2017,including 38 males and 26 females aged 18-79 years,with an average age of 39.2 years.Another 42 cases were treated with selective operation from Nov.2014 to Apr.2016,including 29 males and 13 females aged 21-85 years,with an average age of 40.4 years.All patients were followed up for 10 months-4 years,with an arerage of 12.9 months.American Society of Anesthesiologists(ASA)score,operation time,blood loss,soft tissue infection rate,fracture healing time,Johner-Wruhs score and hospital stay were compared between the two groups.Results The differences between emergency group and selective operation group in the ASA score,operation time,blood loss,fracture healing time,soft tissue infection rate,and the excellent and good rate of Johner-Wruhs score[(2.76±0.85)points vs.(2.60±0.82)points、(68.3±23.4)min vs.(79.4±22.1)min,(285.7±73.1)mL vs.(245.8±77.2)mL,(17.3±6.7)weeks vs.(16.3±5.6)weeks,12.50%vs.11.90%,95.31%vs.93.65%]were not statistically significant(P>0.05).The average hospital stay[(7.5±0.7)days]in the emergency operation group was less than that in the selective operation group[(10.8±1.2)days].Significant difference was found in the hospital stay(P<0.05).Conclusion Emergency operation for closed AO/OTA type 42-A1 distal tibial shaft fractures based on the MIPPO technique is safe and effective,and can reduce hospital stay.