关节镜辅助下微创经皮钢板内固定与传统切开复位内固定对胫骨平台骨折患者的疗效观察  

Observation of the curative effect of minimally invasive percutaneous plate osteosynthesis and traditional open reduction internal fixation in patients with tibial plateau fracture

作　　者：王攀[1] 黄光斌[1] 胡平[1] 李涛[1] WANG Pan;HUANG Guang-bin;HU Ping;LI Tao(Chongqing Emergency Medical Center,Chongqing 400014,China)

机构地区：[1]重庆市急救医疗中心创伤科

出　　处：《创伤外科杂志》2019年第8期615-619,共5页Journal of Traumatic Surgery

摘　　要：目的比较关节镜辅助下微创经皮钢板内固定(MIPPO)与传统切开复位内固定(ORIF)治疗胫骨平台骨折(FTP)患者临床疗效。方法重庆市急救医疗中心创伤科2016年1月—2017年1月收治FTP患者86例,男性46例,女性40例;年龄20~75岁,平均48.8岁。根据手术方式不同将患者分为行ORIF术47例(ORIF组)与行MIPPO术39例(MIPPO组),比较两组患者手术指标:切口长度、手术时间、术后引流量、住院时间、愈合时间,术前、术后1、3d炎症因子[白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)]、氧化应激指标[超氧化物歧化酶(SOD)、皮质醇(Cor)、总抗氧化能力(TAC)],统计两组患者术后1~2年并发症(局部感染、创伤性关节炎、关节僵硬、畸形愈合、皮下组织坏死)发生情况。结果MIPPO组切口长度、手术时间、住院时间、术后引流量及愈合时间均少于ORIF组[(7.08±1.76)cm vs.(12.53±1.54)cm、(74.07±9.45)min vs.(117.28±8.21)min、(11.21±3.62)d vs.(14.46±3.78)d、(120.09±9.84)mL vs.(170.51±10.36)mL、(11.49±2.34)周vs.(15.32±2.18)周]。两组患者术后1、3d IL-6、IL-8及TNF-α均较术前升高(P<0.05),MIPPO组术后1、3d IL-6、IL-8及TNF-α均低于ORIF组(P<0.05)。两组患者术后1、3d SOD、TAC均低于术前,Cor高于术前(P<0.05);MIPPO组术后3d SOD、TAC均高于ORIF组[(68.39±6.42)μ/mL vs.(61.87±7.12)μ/mL、(8.08±1.37)μ/mL vs.(5.77±1.53)μ/mL,P<0.05];MIPPO组术后1、3d Cor低于ORIF组(P<0.05)。MIPPO组术后1~2年并发症总发生率10.26%(4/39)低于ORIF组27.66%(13/47),P<0.05。结论与ORIF术式比较,采用MIPPO术式治疗FTP可显著改善临床手术指标,对患者的炎症反应及氧化应激影响均更小,能够减少术后并发症发生风险。Objective To compare the clinical efficacy of minimally invasive percutaneous plate osteosynthesis(MIPPO)and open reduction and internal fixation(ORIF)in the treatment of patients with tibial plateau fractures(FTP).Methods A total of 86 patients with FTP admitted to our hospital from Jan.2016 to Jan.2017 were selected as the research subjects.They were divided into the ORIF group(n=47,treated with ORIF)and the MIPPO group(n=39,treated with MIPPO).The surgical indicators(length of incision,time of operation,postoperative drainage volume,length of stay,healing time)were compared between the two groups,the inflammatory factors[interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)],oxidative stress indicators[superoxide dismutase(SOD),cortisol(Cor),total antioxidant capacity(TAC)]were compared before surgery,one day after surgery,three days after surgery between the two groups.At the same time,the incidence of postoperative complications(local infection,traumatic arthritis,joint stiffness,malunion,subcutaneous tissue necrosis)were analyzed between the two groups.Results The incision length,operation time,hospitalization time and healing time in the MIPPO group were shorter than those in the ORIF group,and postoperative drainage volume was less than that in the ORIF group(P<0.05).The levels of IL-6,IL-8 and TNF-αat one day after surgery,three days after surgery in the two groups were higher than before operation(P<0.05),the levels of IL-6,IL-8 and TNF-αat one day after surgery,three days after surgery in the MIPPO group were lower than those in the ORIF group(P<0.05).The levels of SOD,TAC at one day after surgery,three days after surgery in the two groups were lower than before operation,and the level of Cor was higher than before operation(P<0.05),the levels of SOD,TAC at three days after surgery in the MIPPO group were higher than those in the ORIF group(P<0.05),and the level of Cor at one day after surgery,three days after surgery in the MIPPO group were lower than that in the ORIF group(P<0.05

关 键 词：胫骨平台骨折 微创 内固定 关节镜 炎症反应 氧化应激 

分 类 号：R68[医药卫生—骨科学]