内外侧锁定钢板治疗胫骨远端关节外骨折的疗效比较

A Comparison of the Efficacy of Medial and Lateral Locking Plates in the Treatment of Distal Tibial Extraarticular Fractures

目的比较分析内侧与外侧锁定钢板内固定治疗闭合型胫骨远端关节外骨折的临床疗效,并明确内外侧锁定钢板各自的优势及适应症。方法回顾性分析2017年10月1日至2021年5月31日某院收治的97例采用锁定钢板内固定治疗胫骨远端关节外骨折的患者的临床资料。根据手术入路分内侧组和外侧组,内侧组53例、外侧组44例,比较两组的手术时间、术中出血量、骨折愈合时间、内固定取出时间及并发症的情况,应用Johnner-Wruhs评分标准评价两组患者术后的功能恢复情况。结果内侧组:40例实施微创复位内固定,13例因微创复位失败改为切开复位内固定;外侧组:9例采用微创复位,35例因微创复位失败改为切开复位内固定。手术时间:内侧组为105(80-130)分钟,外侧组为125(102.5-150)分钟;术中出血量:内侧组为70(50-100)毫升,外侧组为100(52.5-200)毫升;骨愈合时间:内侧组为16(14-18)周,外侧组为18(16-20)周;内固定取出时间:内侧组为19(16-31)周,外侧组为20(18-23)周,差异均有统计学意义(P<0.05)。并发症:内侧组出现皮肤刺激反应8例,切口感染3例,外侧组中所有病例切口均愈合良好,但骨折畸形愈合4例、延迟愈合1例、踝关节活动受限4例、踝关节疼痛3例。术后患者随访(19.7±4.8)个月。末次随访时,根据Johnner-Wruhs评分标准,内侧组:优42例,良7例,可2例,差2例;外侧组:优30例,良9例,可2例,差3例(P>0.05)。结论内侧锁定钢板固定优于外侧固定,但当骨折线贴近关节面、骨折呈粉碎骨折、骨折存在扭转暴力、胫骨内侧软组条件差、单一切口固定胫腓骨骨折时,外侧固定更优;术中应优先采用微创复位,但微创复位困难时需行切开复位。

Objectives To compare and analyze the clinical efficacy of internal fixation with medial locking plate and lateral locking plate in the treatment of closed extraarticular fracture of distal tibia.Methods A retrospective analysis was performed on the clinical data of 97 patients with extraarticular distal tibial fractures treated with locked plate internal fixation in our hospital from October 1st,2017 to May 31st,2021.According to the surgical approach,there were 53 patients in the medial group and 44 patients in the lateral group.The operative time,intraoperative blood loss,fracture healing time,internal fixation removal time and complications in the two groups were compared.The Johnner-Wruhs scoring scale was used to evaluate the postoperative functional recovery of the two groups.Results In the medial group,40 cases were treated with minimally invasive reduction and internal fixation,and 13 cases were treated with open reduction and internal fixation due to the failure of minimally invasive reduction.In the lateral group,9 cases were treated with minimally invasive reduction,and 35 cases were treated with open reduction and internal fixation due to the failure of minimally invasive reduction.The operation time was(105(80-130))min in the medial group and(125(102.5-150))min in the lateral group.Intraoperative blood loss was(70(50-100))ml in the medial group and(100(52.5-200))ml in the lateral group.The bone healing time was(16(14-18))weeks in the medial group and(18(16-20))weeks in the lateral group.The removal time of internal fixation was(19(16-31))weeks in the medial group and(20(18-23))weeks in the lateral group,and the differences were statistically significant(P<0.05).In terms of complications,there were 8 cases of skin irritation and 3 cases of wound infection in the medial group.All the cases in the lateral group had good wound healing,but there were 4 cases of fracture malunion,1 case of delayed union,4 cases of ankle movement limitation,and 3 cases of ankle pain.Postoperative patients were followed up for(19.7±4.8)months.At the last follow-up,according to Johnner-Wruhs scoring standard,42 patients in the medial group were excellent,7 were good,2 was fair,and 2 were poor.In the lateral group,30 cases were excellent,9cases were good,2 cases were fair and 3 cases were poor(P>0.05).Conclusions Medial locking plate fixation was better than lateral fixation,but when the fracture line was close to the articular surface,the fracture was comminuted,the fracture had torsional force,the condition of the soft medial tibia group was poor,and the tibia and fibula fracture was fixed by a single incision,the lateral fixation was better.Intraoperative minimally invasive reduction should be preferred,but open reduction should be performed when minimally invasive reduction was difficult.