有限切开与闭合复位钢板内固定治疗胫骨下段骨折的效果比较分析

Comparative analysis of limited incision reduction and closed reduction in the treatment of distal tibial fractures

目的比较有限切开复位与闭合复位内固定术治疗胫骨下段骨折的临床疗效。方法回顾性分析我院2016年1月至2019年1月胫骨下段骨折患者资料,依据术中是否切开骨折断端将患者分为有限切开组和闭合组,入选病例63例,其中男45例,女18例,平均年龄(42.0±13.7)岁。有限切开组33例、闭合组30例,术后随访至骨折完全愈合。观察手术时间骨痂形成与骨折愈合时间、复位准确率及并发症发生情况。结果平均随访时间为(13.4±1.8)个月,所有患者骨折均获愈合,其中1例患者出现延迟愈合。有限切开组与闭合组比较手术时间[(79.4±17.4)min vs.(75.6±19.4)min,P=0.783]、出现骨痂时间[(9.5±3.4)周vs.(10.1±4.0)周,P=0.548]、骨折愈合时间[(19.2±3.4)vs.(18.6±5.4),P=0.241]、Johner-Wuhs评分优良率(84.7%vs.86.7%,P=0.837)及并发症情况(P=0.154)差异均无统计学意义。两组复位准确性相比,有限切开复位明显高于闭合组(29/33 vs.21/30,P=0.033)。结论有限切开复位与闭合复位内固定术在治疗胫骨下段骨折时均取得良好效果,但有限切开较闭合复位有利于准确复位。

Objective To compare the clinical effect of limited incision reduction and closed reduction of MIPPO(minimally invasive persistent plate osteosynthesis)in the treatment of distal tibial fractures.Methods Clinical data of patients with distal tibial fracture in Beijing Tongren Hospital from January 2016 to January 2019 were retrospectively analyzed.All 63 patients were divided into limited incision reduction group(n=33)and closed reduction group(n=30),including 45 males and 18 females with the mean age of(42.0±13.7)years.All patients were followed up until fracture healing.Operation time,callus formation,fracture healing time,reduction accuracy and complications were analyzed.Results The mean follow-up was(13.4±1.8)months.All fractures were healed,besides 1 patients with delayed union.There were no statistical differences in operation time[(79.4±17.4)min vs.(75.6±19.4)min,P=0.783],callus formation[(9.5±3.4)weeks vs.(10.1±4.0)weeks,P=0.548],fracture healing time[(19.2±3.4)weeks vs.(18.6±5.4)weeks,P=0.241],Johner-Wuhs score(84.7%vs.86.7%,P=0.837)and complications(P=0.154)between the limited incision group and closed reduction group.However,reduction accuracy of the limited incision group was significantly higher than that of the closed reduction group(29/33 vs.21/30,P=0.033).Conclusions Both limited incision reduction and closed reduction are effective in the treatment of distal tibial fracture,while the former has higher reduction accuracy.