胫骨远端内侧锁定钢板微创内固定对闭合性胫腓骨中下段骨折患者炎性因子的影响

Effects of minimally invasive internal fixation with distal medial tibial locking plate on inflammatory factors in patients with closed middle-lower tibiofibular fractures

目的 分析胫骨远端内侧锁定钢板微创内固定治疗闭合性胫腓骨中下段骨折患者的效果。方法 选取清丰县第三人民医院84例闭合性胫腓骨中下段骨折患者(2019年2月—2020年8月),依照随机数字表分为两组,各42例。对照组接受胫骨远端前外侧切开复位内固定治疗,观察组接受胫骨远端内侧锁定钢板微创内固定治疗,比较两组治疗效果、踝关节功能及炎性因子水平。结果 术后6个月,观察组手术优良率(92.86%)较对照组(73.81%)高(P<0.05);观察组手术时间及骨折愈合时间较对照组短,切口较对照组小,术中失血量较对照组少(P<0.001);术后3个月、6个月,两组踝关节功能均得到提升,且观察组美国骨科足踝协会(AOFAS)踝-后足评分量表评分均较对照组高(P<0.01);术后3 d,两组血清肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、C反应蛋白(CRP)、血沉(ERS)均较术前高,但观察组均低于对照组(P<0.001)。结论 胫骨远端内侧锁定钢板微创内固定治疗闭合性胫腓骨中下段骨折效果显著,能优化手术及术后恢复指标,改善患者踝关节功能,减小对炎性因子水平的影响。

Objective To analyze the efficacy of minimally invasive internal fixation with distal medial tibial locking plate in the treatment of closed middle-lower tibiofibular fractures. Methods 84 patients with closed middle-lower tibiofibular fractures in the Third People’s Hospital of Qingfeng County from February 2019 to August 2020 were selected and divided into two groups with 42 cases in each group according to random number table. The control group received the distal tibial anterolateral open reduction and internal fixation, while the study group was given the minimally invasive internal fixation with the distal medial tibial locking plate. The efficacy of treatment, ankle joint function, and levels of inflammatory factors were compared between the two groups. Results Six months after operation, the superior rate of operation in study group(92.86%) was higher than that in control group(73.81%)(P<0.05), and the study group had shorter durations of operation and fracture healing with smaller size of incision and less amount of intraoperative blood loss than the control group(P<0.001). 3 and 6 months after operation, ankle function was improved in both groups, and the scores based on the ankle-hind foot scale of American Orthopedic Foot and Ankle Association(AOFAS) in study group were all higher than those in the control group(P<0.01). 3 days after operation, the levels of serum tumor necrosis factor-α(TNF-α), procalcitonin(PCT), C-reactive protein(CRP), and erythrocyte sedimentation(ERS) in both groups were all higher that those before operation, but those levels in study group were all lower than those in control group(P<0.001). Conclusion The minimally invasive internal fixation with distal medial tibial locking plate has a significant positive effect in the treatment of closed middle-lower tibiofibular fractures, which can optimize the operation and postoperative recovery index, improve the ankle joint function, and reduce the influence on the levels of inflammatory factors.