不同固定术治疗胫骨下段骨折的疗效

Effects of different fixation methods in the treatment of middle and lower tibial fractures

目的:探究小切口下闭合复位微创钢板固定(MIPO)术与闭合复位交锁髓内钉术治疗胫骨中下段骨折的疗效。方法:根据闭合复位方式不同将110例胫骨中下段骨折患者分为MIPO组(n=52)和髓内钉组(n=58)。MIPO组采用小切口下闭合复位MIPO术;髓内钉组采用闭合复位交锁髓内钉术。比较两组围手术期指标、内固定相关并发症及术后软组织血运情况、骨折愈合评分、Johner-Wruhs评分。结果:MIPO组手术耗时短于髓内钉组(P<0.05),术中出血量、切口长度均小于髓内钉组(P<0.05);两组术后内固定松动、断裂发生率及并发症总发生率差异均无统计学意义(P>0.05);术后1个月,MIPO组皮肤坏死、皮温低、发绀/瘀血等软组织血运不良事件总发生率低于髓内钉组(P<0.05);两组术后1个月、6个月、末次随访骨折愈合评分及末次随访Johner-Wruhs评分优良率差异均无统计学意义(P>0.05)。结论:两种固定术在骨折愈合、内固定稳定性及膝、踝关节功能恢复方面无显著差异,但小切口下闭合复位MIPO术对周围软组织损伤小,术后软组织血运恢复速度快于闭合复位交锁髓内钉术。

Objective:To explore the effects of small-incision closed reduction minimally invasive plate osteosynthesis(MIPO)and closed reduction interlocking intramedullary nail in the treatment of middle and lower tibial fractures.Methods:110 patients with middle and lower tibial fractures were included.Among the patients,52 cases underwent small-incision closed reduction MIPO(MIPO group),and 58 cases received closed reduction interlocking intramedullary nail(intramedullary nail group).Perioperative indicators,internal fixation-related complications,postoperative soft tissue blood supply status,fracture healing score and Johner-Wruhs score were compared between groups.Results:The surgical time in MIPO group was shorter(P<0.05),and the intraoperative blood loss and incision length were less or shorter than those in intramedullary nail group(P<0.05).The incidence rates of postoperative internal fixation loosening and fracture and total incidence rate of complications revealed no statistical differences between the two groups(P>0.05).The total incidence rate of adverse events of soft tissue blood supply such as skin necrosis,low skin temperature and cyanosis/blood stasis in MIPO group was lower than that in intramedullary nail group at 1 months after surgery(P<0.05).There were no statistically significant differences in fracture healing scores at 1 and 6 months after surgery and at the last follow-up and excellent and good rate of Johner-Wruhs score at the last follow-up between the two groups(P>0.05).Conclusion:Both fixation methods have no significant differences in fracture healing,internal fixation stability and functional recovery of knee and ankle joints.However,small-incision closed reduction MIPO has less damage to the surrounding soft tissues and faster postoperative recovery of soft tissue blood supply.