富血小板血浆联合MIPPO治疗闭合性胫骨干骨折的临床疗效观察

Platelet-Rich Plasma Combined with MIPPO Technique in Treatment of Tibial Closed Fracture

目的 探讨微创经皮钢板内固定术(minimally invasive percutaneous plate osteosynthesis,MIPPO)联合应用富血小板血浆(platelet-rich plasma,PRP)治疗闭合性胫骨干骨折的临床疗效。方法 选取青岛大学附属威海市中心医院自2019年1月到2020年5月收治的62例新鲜闭合胫骨干骨折患者。按照随机数字表法将患者分为对照组和治疗组,每组各31例。治疗组采用MIPPO的同时骨折断端应用PRP治疗,对照组为单纯用MIPPO治疗,不应用PRP。治疗组男19例,女12例;年龄19~60岁,平均(38.48±12.01)岁。对照组男21例,女10例;年龄19~57岁,平均(39.77±12.31)岁。记录并比较两组患者手术时间、术中出血量、骨折愈合时间、完全负重时间、并发症发生情况、术后12个月Johner-Wruhs优良率等。结果 患者均获随访,随访时间12个月以上。治疗组完全负重时间、骨折愈合时间、切口愈合情况均优于对照组,差异均有统计学意义(P<0.05)。术后12个月采用Johner-Wruhs标准评价疗效,治疗组:优27例,良2例,中2例,优良率为93.55%;对照组:优19例,良3例,中5例,差4例,优良率70.97%。治疗组疗效优于对照组,差异有统计学意义(P<0.05)。治疗组患者骨折均愈合,术后无明显并发症发生。对照组1例浅表感染,经换药切口愈合;1例延迟愈合,术后11个月骨折愈合。结论 PRP联合MIPPO技术能明显缩短骨折愈合时间,减少骨折延迟愈合,减少术后并发症,提高患肢功能活动,且未出现明显并发症,具有临床应用价值。

Objective To investigate the effect of minimally invasive percutaneous plate osteosynthesis(MIPPO)combined with platelet-rich plasma(PRP) for tibial shaft closed fractures.Methods A total of 62 patients with freshly closed tibial shaft fractures admitted to Weihai Central Hospital affiliated to Qingdao University from January 2019 to May 2020 were selected.Patients were divided into control group and treatment group according to random number table method,with 31 cases in each group.The treatment group with minimally invasive percutaneous plate fixation MIPPO at the same time of fracture end applications of PRP treatment.The control group was treated with MIPPO alone without PRP.In the treatment group,there were 19 males and 12 females.The average age was(38.48±12.01)years,ranging from 19~60 years.In the control group,there were 21 males and 10 females.The average age was(39.77±12.31) years;ranging from 19~57 years.Operation time,intraoperative blood loss,fracture healing time,complete weight-bearing time,complications,Johner-Wruhs excellent and good rate 12 months after surgery were recorded and compared between the two groups.Results All patients were followed up for more than 12 months.The complete weight-bearing time,fracture healing time and incision healing in the treatment group were better than those in the control group,and the differences were statistically significant(P<0.05).The curative effect was evaluated by JohnerWruhs criteria 12 months after surgery.In the treatment group,27 cases were excellent,2 cases were good,and 2 cases were medium,with an excellent and good rate of 93.55%.In the control group,19 cases were excellent,3 cases were good,5 cases were medium;and 4 cases were poor,with an excellent and good rate of 70.97%,The therapeutic effect of the treatment group was better than that of the control group,and the difference was statistically significant(P 0.05).All fractures healed in the treatment group,and no obvious complications occurred after operation.One case of superficial infection in control group was cured by dressing change.Delayed fracture of union was observed in 1patients,and the fracture healed until 11 months after surgery.Conclusion PRP combined with MIPPO technique can significantly shorten fracture healing time,reduce delayed fracture healing,reduce postoperative complications,and improve the functional activity of the affected limb,without obvious complications,which has clinical application value.