内侧与外侧经皮微创钢板内固定治疗A型闭合性胫骨远端骨折的疗效比较  

Comparison of medial and lateral minimally invasive internal fixation in treatment of type A closed distal tibial fractures

作　　者：石伟哲[1] 肖海军 

机构地区：[1]广州市花都区人民医院骨科,广东510800 [2]上海市奉贤区中心医院骨科

出　　处：《中国骨与关节损伤杂志》2015年第6期606-609,共4页Chinese Journal of Bone and Joint Injury

基　　金：上海市卫生局科研课题(20134204)

摘　　要：目的比较分析应用外侧与内侧微创经皮钢板接骨术（MIPPO）联合锁定加压钢板（LCP）内固定治疗AO分型中A型闭合性胫骨远端骨折的临床疗效。方法自2007-06—2010-08,应用MIPPO技术联合LCP内固定治疗60例A型闭合性胫骨远端骨折,其中采用胫骨远端内侧锁定钢板内固定30例（内侧组）,采用胫骨远端外侧锁定钢板内固定30例（外侧组）。记录并比较2组临床指标（手术时间、术中出血量、骨折愈合时间、并发症、AOFAS评分、背屈活动范围、跖屈活动范围、短缩长度）及影像学指标（内翻畸形、外翻畸形、前向成角、后向成角）。结果内侧组获得随访平均14.8（12～18）个月,外侧组获得随访平均16.7（12～20）个月。内侧组手术时间及术中出血量均少于外侧组,差异有统计学意义（P〈0.05）。2组骨折愈合时间,并发症发生情况,内、外翻畸形,前、后向成角,背、跖屈活动范围,肢体短缩长度,以及AOFAS评分差异无统计学意义（P〉0.05）。结论 MIPPO技术结合LCP钢板内固定治疗胫骨远端骨折时,内侧固定相对于外侧固定更符合骨折愈合的生物环境,具有创伤小、血运损伤小等优点。但是2种固定方法的短期疗效差异不大,临床治疗过程中仍需根据患者实际情况选择合适的手术方式。Objective To compare the clinical results of medial and lateral minimally invasive pereutaneous plate osteosynthesis （MIPPO） unite looking compression plate （LCP） internal fixation technique in treatment of AO-type A closed distal tibial fractures. Methods From June 2007 to August 2010, 60 cases of AO-type A closed distal tibia fractures with application of MIPPO technology with LCP internal fixation were divided into two groups according to the method of reduction. Thirty cases were treated with medial plate as medial group and 30 cases were treated with lateral plate as lateral group.The clinical indicators （operation time, intraoperative blood loss, fracture healing time, complications, AOFAS score, dorsiflexion range, plantar flexion range, shortening the length） and imaging index of the two groups （valgus and varus deformity to angle and back angle）were recorded and compared. Results The medial group was followed for an average of 14.8 months（12 to 18 months）, the lateral group for an average of 16.7 months （12 to 20 months）. The medial group＇s bleeding amount of operating time were less than the lateral group, the difference was statistically significant （P 〈0.05）. Between the two groups in fracture healing time, complications, and valgus deformity, before and after the angulation, back, plantar flexion range, limb shortening length, and AOFAS score there were no statistically significant differences （P 〉0.05）. Conclusion Using MIPPO technology combined with LCP plate internal fLxation for distal tibial fracture, medial plate relative to the lateral plate group is more in line with the biological environment of bone healing. Medial plate fixation has the advantages of less trauma and injury of blood supply. But in the short-term efficacy between two methods there is little difference. The appropriate operation method should be chosen according to the actual condition of the patients in treament.

关 键 词：闭合性胫骨远端骨折 A型骨折 微创经皮钢板接骨术 内侧固定 外侧固定 

分 类 号：R687.3[医药卫生—骨科学]