微创接骨术在高能量胫骨上段骨折中的应用研究  

Application of minimally invasive plate osteosynthesis in high energy comminuted fractures of proximal tibia

作　　者：杨俊生[1] 童梁成 孙中洋[1] 谭权昌 汪剑龄[1] 茆文龙 李颖[1] 

机构地区：[1]解放军第454医院骨科,江苏南京210002

出　　处：《中国矫形外科杂志》2017年第24期2243-2247,共5页Orthopedic Journal of China

基　　金：军区医学科技创新课题项目(编号:11MA059);国家自然科学基金项目(编号:81600694)

摘　　要：[目的]比较研究微创接骨术(minimally invasive plate osteosynthesis,MIPO)与切开复位内固定术(open reduction and internal fixation,ORIF)治疗高能量胫骨上段骨折的临床疗效。[方法]回顾性分析本科2012年8月~2016年3月收治的69例AO 41-C2型胫骨上段骨折患者资料,根据手术方法分为MIPO组(37例)和ORIF组(32例)。两组年龄、性别、受伤原因、软组织损伤程度以及伤后至手术时间的比较差异均无统计学意义(P>0.05)。比较两组手术时间、术中失血量、骨折愈合时间和并发症。[结果]MIPO组手术时间显著短于ORIF组(t=2.287,P=0.027),术中失血量显著少于ORIF组(t=2.820,P=0.007);术后4例发生切口皮缘坏死,其中MIPO组1例(2.70%),ORIF组3例(9.38%),均发生在Tscherne3级软组织损伤病例,切口皮缘坏死发生率比较差异有统计学意义(P<0.05)。两组患者均获随访,随访时间12~25个月,平均18个月。两组骨折愈合时间差异无统计学意义(t=1.608,P=0.115)。MIPO组2例(5.41%)发生内翻畸形愈合,ORIF组1例(3.13%),均无需矫形手术,两组畸形愈合率差异无统计学意义(χ~2=1.665,P=0.579)。末次随访时两组患者HSS膝关节功能评分差异无统计学意义(t=1.296,P=0.201)。[结论]MIPO和ORIF治疗AO 41-C2型胫骨上段骨折均可获得较好临床疗效,但MIPO对组织损伤小,手术时间短,术中失血少,术后软组织并发症发生率低,更适用于软组织损伤严重的高能量骨折。[Objective] To compare minimally invasive plate osteosynthesis （MIPO） versus open reduction and internal fixa- tion （ORIF） for treatment of AO Type 41-C2 fracture. [Methods] A retrospective analysis was conducted on 69 patients with AO Type 41-C2 fracture surgically managed between August 2012 and March 2016. Of the 69 patients, 37 patients were treat- ed with bllPO （the MIPO group） , while the remaining 32 patients treated with ORIF （the ORIF group） . There were no signifi- cant differences in gender, age, cause of injury, injury severity of enveloping soft tissue, and time interval from injury to opera-tion between the two groups （P〉0.05）. The operative time, in- tra-operative blood loss, fracture healing time, and complica- tions were compared between the two groups. [Results] The operative time in MIPO group was significantly shorter than that in the ORIF group （t= 2.287, P=0.027）, associated with significantly lesser intra-operative blood loss than the ORIFgroup （t=2.820, P=0.007）. Skin necrosis at incision edge occurred in 4 patients, includingl in the MIPO group （2.70%） and 3 in the ORIF group （9.38%） , all the 4 patient had Tscheme Grade 3 soft tissue injury, with significant difference between the two groups （P〈0.05） . All the patients were followed up for 12 to 25 months with a mean of 18months. No significant difference was found in the average bone healing time between the 2 groups （t=1.608, P=0.115）. Malunion happened in 2 patients of the MIPO group （5.41%） , whereas 1 patient of the ORIF group （3.13%） , without significant difference between them （χ2=1.665, P= 0.579） . In addition, no significant difference was noted in HSS score between the two groups （t=1.296, P=0.201） . [Conclusion] Both MIPO and ORIF have good results for treating AO Type 41-C2 fractures. By comparison, MIPO is superior to ORIF for treating the high-energy fractures especially with concomitant severe soft tissue lesions.

关 键 词：高能量胫骨上段骨折 微创钢板接骨术(MIPO) 切开复位内固定(ORIF) 软组织损伤 

分 类 号：R687.3[医药卫生—骨科学]