微创经皮钢板固定术与交锁髓内钉治疗胫骨远端关节外骨折疗效的观察  

Locked plating with minimally invasive percutaneous plate osteosynthesis versus intramedullary nailing of distal extra-articular tibial fracture： a retrospective study

作　　者：姚琦[1] 倪杰[1] 彭立彬[1] 于大昕[1] 袁晓明[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院骨科,100038

出　　处：《中华医学杂志》2013年第47期3748-3751,共4页National Medical Journal of China

基　　金：北京市科技新星计划（2011085）

摘　　要：目的观察比较微创经皮钢板固定术（MIPPO）与交锁髓内钉（IMN）治疗胫骨远端关节外骨折的治疗效果。方法回顾性分析2005年1月至2011年12月首都医科大学附属北京世纪坛医院骨科6l例MIPPO锁定加压钢板和65例IMN治疗胫骨远端关节外骨折患者的手术时间、骨折愈合时间、末次随访足踝功能评分（AOFAS评分）及并发症情况。结果随访12～53个月，平均23．7个月，患者的手术时间、骨折愈合时间、末次随访足踝功能评分（AOFAS）评分差异均无统计学意义[（17．3±3．8）、（16．5±3．1）周，P=0．193；（83．2±11．9）、（84．9±12．0）分，P=0．426]。并发症发生率方面，IMN组的畸形愈合发生率和膝关节疼痛发生率高于MIPPO锁定钢板组，差异有统计学意义（分别为：P=0．015，P=0．025）。结论MIPPO技术锁定加压钢板和IMN都是治疗胫骨远端关节外骨折的有效方法，而从畸形愈合和膝关节疼痛发生率来看，MIPPO技术锁定加压钢板更具优势。Objective To compare the efficacies of minimally invasive plate osteosynthesis （MIPPO） and interlocking intramedullary nailing （IMN） in the treatment of extra-articular fractures of distal tibia. Methods Retrospective reviews were conducted for 126 patients with extra-articular distal tibia fractures. Treatment was either MIPPO （ n = 61 ） or IMN （ n = 65 ） . The outcomes were assessed by comparing operating duration, time to union, the last follow-up American Orthopedic Foot and Ankle Society （AOFAS） score and complication rate. Results The average follow-up period was 23.7 （12 -53 ） months. In the minimally invasive plate osteosynthesis group, there were deep infections （ n = 2）, superficial infections （n =5） , delayed union （n =2） , malunion （n =2） and knee joint pain （n = 10） were observed. In addition, the average operating duration （ 85.9 ＋ 18.9 min） , average time to union （ 17.3 -＋ 3.8 weeks） and average AOFAS （ 83.2 ~ 11.9 ） were analyzed. In the interlocking intramedullary nailing group, there were delayed union （n = 3）, malunion （n = 12） and knee joint pain （n = 22）. And the average operating duration （83.3-＋ 15.7 rain）, average time to union （16. 5 _＋ 3. 1 weeks） and average AOFAS （84. 9 ＋ 12. 0） were analyzed. No statistical significance existed in operating duration, time to union and the last follow-up AOFAS between two groups （ P 〉 0.05 ）. However, the rates of malformation and knee joint pain were higher in the intramedullary nail group than those in the plate group. And the difference was statistically significant （ P = 0. 015, P = O. 025 ）. Conclusion Both MIPPO and IMN are effective for extra-articular fractures of distal tibia. However, the former has the advantage of lowers rate of malformation and knee joint pain. Therefore a surgeon should consider the degree of injury while managing extra-articular fracture of distal tibia.

关 键 词：外科手术 最小侵入性 骨折固定术 内 胫骨骨折 骨钉 

分 类 号：R687.3[医药卫生—骨科学]