经皮微创接骨板、外固定支架、专家级髓内钉固定治疗43-A型胫骨骨折的临床疗效比较

To Compare and Analyze the Clinical Effects and Indications of 43-A Tibial Fracture(AO Type)Treatment by Different Methods:Percutaneous Minimally Invasive Osteosynthesis,External Fixation and Expert Intramedullary Nail

【目的】对比分析经皮微创接骨板(MIPPO)、外固定支架、专家级髓内钉固定方法(ETN)治疗AO分型43-A型胫骨骨折的临床疗效及适应证。【方法】选取2017年4月至2019年10月于本院就诊接受手术治疗的胫骨骨折128例患者为研究对象,根据治疗方式的不同分为三组:经皮微创接骨板(A组,42例),外固定支架(B组,43例),专家级髓内钉固定(C组,43例)。对比三组患者手术时间、术中出血量、骨折愈合时间及住院时间等指标和患者术后1、3、6个月X线复查的骨折愈合情况。比较三组患者美国足踝外科协会(AOFAS)足-踝功能评分(AOFAS评分)及其评分功能优良率和术后并发症的发生率。【结果】B组患者术中出血量、骨折愈合时间高于A组、C组(P<0.05),手术时间显著低于A组、C组,差异具有统计学意义(P<0.05);三组患者足-踝功能优良率及AOFAS评分比较,E组显著低于A组、C组(P<0.05);三组患者并发症总发生率比较,差异无统计学意义(P>0.05)。【结论】三种手术方法对于AO分型43-A型胫骨骨折患者均有一定治疗效果,临床首选内固定术治疗,对于不适合内固定治疗的患者,可采用远端交叉置钉避免跨踝关节的外固定法进行治疗。

【Objective】To compare and analyze the clinical effects and indications of 43-A tibial fracture(AO type)treatment by MIPPO(minimally invasive percutaneous plate osteosynthesis),external fixation and ETN(expert intramedullary nail).【Methods】From April 2017 to October 2019,128 patients with tibial fracture who were treated by operation in our hospital were selected as the research objects.According to the different treatment methods,they were divided into three groups:percutaneous minimally invasive plate(42 cases in group A),external fixation frame(43 cases in group B)and expert intramedullary nail fixation(43 cases in group C).The operation time,intraoperative hemorrhage,fracture healing time and hospitalization time were compared among the three groups.X-ray examination was performed at 1,3 and 6 months after operation.The AOFAS score,the rate of excellent scoring function and the incidence of postoperative complications were compared among the three groups.【Results】The bleeding volume and fracture healing time in group B were higher than those in group A and group C(P<0.05),and the operation time in group B was significantly lower than that in group A and group C(P<0.05);The excellent rate of scoring ankle function and AOFAS score in group B were significantly lower than those in group A and C(P<0.05);there was no statistical significance in the total incidence of complications among the three groups(P>0.05).【Conclusion】Three kinds of surgical methods have certain therapeutic effect on the patients with AO 43-A tibial fracture.The first choice is internal fixation.For the patients who are not suitable for internal fixation,the distal cross nail is used to avoid external fixation across the ankle joint.