摘要
目的：比较损伤早期与延期微创经皮钢板接骨术（minimally invasive percutaneous plate osteosynthesis,MIPPO）治疗胫骨远侧干骺端粉碎性骨折的临床效果。方法：自2006年1月至2012年1月,采用MIPPO技术治疗闭合性胫骨远侧干骺端粉碎性骨折患者66例。根据手术时机将患者分为两组,早期手术组31例,男18例,女13例;年龄21~57岁,平均（39.0±17.8）岁;在损伤早期即实施MIPPO手术;其中Tscherne软组织损伤Ⅰ级18例,Ⅱ级12例,Ⅲ级例1例。延期手术组35例,男16例,女19例;年龄24~55岁,平均（39.5±15.2）岁;延期接受MIPPO手术;其中Tscherne软组织损伤Ⅰ级6例,Ⅱ级26例,Ⅲ级3例。记录并观察两组患者的手术时间、术中出血量、住院时间、骨折愈合时间及并发症等情况,末次随访时采用Lowa踝关节评分评价患者的功能疗效,采用正侧位X线片评估骨折复位维持及对线情况。结果：两组患者均获随访,早期手术组随访（13.5±3.5）个月,延期手术组随访（15.2±3.8）个月,两组比较差异无统计学意义（t=1.882,P=0.064）。两组手术时间、术中出血量比较差异无统计学意义（P〉0.05）,但早期手术组的住院时间明显短于延期手术组（P〈0.05）。早期手术组与延期手术组的平均骨折愈合时间分别为（5.5±2.8）个月和（6.2±3.1）个月,组间比较差异无统计学意义（t=0.958,P=0.342）;两组末次随访时Lowa踝关节评分分别为87.6±6.8和89.6±5.2,组间比较差异无统计学意义（t=1.351,P=0.182）。早期手术组中术后2例发生腓骨切口周围浅表炎症反应;延期手术组中术后1例胫骨切口周围浅表炎症反应,另有1例术后4个月时发生切口深部迟发性感染,两组术后软组织并发症发生率分别为6.5%和5.7%,两组比较差异无统计学意义（χ2=0.016,P=0.900）。结论：对于术前软组织损伤较轻的TscherneⅠ、Ⅱ级胫骨远侧干骺端粉碎性骨折实施损伤早期MIPPO技术治疗并不会显著增加患者的术后软组织并发症发生率,可实现与延期MIPPO技术相当的临床效果。
Objective：To compare clinical outcomes of minimally invasive percutaneous plate osteosynthesis （MIPPO） in treating distal tibial comminuted fractures at early and delayed stage. Methods：From January 2006 to January 2012,66 patients with distal tibial comminuted fractures were treated by MIPPO. All patients were divided into primary group and delayed group according to operation time. There were 31 patients in primary group ,including 18 males and 13 females aged 21 to 57 years old with an average of（39.0＋17.8）, treated by MIPPO at primary stage, according to Tscherne soft tissue injury, 18 cases were grade Ⅰ , 12 cases were grade Ⅱ and 1 case were grade m. Thirty-five patients were treated by MIPPO at delayed stage, including 16 males and 19 females aged 24 to 55 years old with an average of （39.5± 15.2）, according to Tscherne soft tissue injury, 6 cases were grade I , 26 cases were grade Ⅱand 3 cases were grade m. Operation time,blood loss, hospital stay, fracture healing time and complications of two groups were recorded and observed,Lowa scoring of ankle joint were used to evalu- ated therapeutic effects at final following and AP and lateral X-rays were used to evaluated fracture reduction and alignment. Results：All patients were followed up, the time of following-up of primary group was （13.5±3.5） months, （15.2±3.8） months in delayed group, there was no significant meaning between two groups （t= 1.882, P=0.064 ）. There was no significant differences between two groups in operation time and blood loss （〉0.05）, but hospital stay in primary group was shorter than that of delayed group （P〈0.05）. There was no significant meaning between primary group （5.5±2.8） and delayed group （6.2±3.1） in frac- ture healing time（t=0.958 ,P=0.342） ;there was no significant meaning between primary group （87.6±6.8） and delayed group （89.6±5.2） in Lowa scores at final following-up（t=l.351 ,P=0.182）. Two cases occurred postoperative superficial inflammatory reaction around fibular incision in primary group, 1 case occurred postoperative superficial inflammatory reaction around fibular incision and 1 case occurred delayed deep incision infection in delayed group at four months after operation. There was no significant differences in incidence of postoperative soft tissue complications between primary group （6.5%） and delayed group （5.7%） （X2=0.016, P=0.900）. Conclusion：For distal tibial comminuted fractures with grade I and I1 of Tscherne soft tissue in- jury, MIPPO at primary stage can not increase incidence of soft tissue complications, also can obtain the same clinical outcomes just like delayed MIPPO.
出处
《中国骨伤》
CAS
2014年第6期508-512,共5页
China Journal of Orthopaedics and Traumatology
关键词
胫骨骨折
骨折
粉碎性
外科手术
微创性
Tibial fractures
Fractures, comminuted
Surgical procedure,minimally invasive
作者简介
通讯作者：李强E—mail：xslq2007@163．com
