两种方式治疗胫骨中下段骨折的疗效比较

Comparison effect of two methods in the treatment of middle and lower tibial fractures

目的比较经皮微创锁定钢板内固定(MIPPO)和交锁髓内钉内固定治疗胫骨中下段骨折的疗效。方法将90例胫骨中下段骨折患者按治疗方法不同分为髓内钉组(采用交锁髓内钉内固定治疗,40例)和MIPPO组(采用MIPPO治疗,50例)。记录并发症情况和骨折愈合时间。术后1年采用Johner-Wruhs评分和疼痛VAS评分评价疗效。结果90例患者均获得随访,时间14~24个月。髓内钉组发生膝关节疼痛2例,感染1例;MIPPO组发生浅部感染1例。骨折愈合时间髓内钉组较MIPPO组短,但差异无统计学意义(P>0.05)。术后1年,Johner-Wruhs评分优良率髓内钉组高于MIPPO组,差异有统计学意义(P<0.05);VAS评分髓内钉组低于MIPPO组,但差异无统计学意义(P>0.05)。结论MIPPO和交锁髓内钉内固定治疗胫骨中下段骨折均可取得理想效果,但交锁髓内钉内固定治疗术后功能评分更好。

Objective To compare the effect of minimally invasive percutaneous plate osteosynthesis(MIPPO)and interlocking intramedullary nail internal fixation in the treatment of middle and lower tibial fractures.Methods According to the treatment method,90 cases of middle and lower tibial fractures were divided into intramedullary nail group and MIPPO group,40 cases were treated with interlocking intramedullary nail,50 cases were treated with MIPPO internal fixation.The complications and the fracture healing time were recorded,Johner-Wruhs score and pain VAS were used to evaluate the effect at 1 year after operation.Results All 90 cases were followed up for 14~24 months.In the intramedullary nail group,there were 2 cases of knee joint pain and 1 case of infection.In the MIPPO group,there was 1 case of superficial infection.The healing time of intramedullary nail group was shorter than that of MIPPO group,but the difference was not statistically significant(P>0.05).At 1 year postoperation,the Johner-Wruhs score excellent-good rate of the intramedullary nail group was higher than that of MIPPO group(P<0.05).VAS of intramedullary nail group was lower than MIPPO group,while the difference was not statistically significant(P>0.05).Conclusions MIPPO and interlocking intramedullary nail internal fixation can achieve ideal results in the treatment of middle and lower tibial fractures,but the functional score of interlocking intramedullary nail is better.