下肢骨折轴向牵引器辅助微创接骨板技术治疗复杂胫骨平台骨折  

Minimally invasive plate oseosynthesis assisted by a self-designed lower limb axial tractor for treatment of complex tibial plateau fractures

作　　者：袁昊龙 王志刚[1] 贾龙[1] 王兆林[1] 张锴[1] 杜刚强[1] 李朋[1] 蒋昇源 宫智浩 Yuan Haolong;Wang Zhigang;Jia Long;Wang Zhaolin;Zhang Kai;Du Gangqiang;Li Peng;Jiang Shengyuan;Gong Zhihao(Department of Orthopeadics,Hospital Affiliated to Binzhou Medical College,Binzhou 256600,China)

机构地区：[1]滨州医学院附属医院创伤骨科,山东省滨州市256600

出　　处：《中华创伤骨科杂志》2019年第11期959-965,共7页Chinese Journal of Orthopaedic Trauma

基　　金：山东省医药卫生科技发展计划(2017WS229)。

摘　　要：目的探讨下肢骨折轴向牵引器辅助微创接骨板技术(MIPO)治疗复杂胫骨平台骨折的疗效。方法回顾性分析2015年6月至2018年4月滨州医学院附属医院创伤骨科采用MIPO技术治疗的31例复杂骨折患者资料。依据治疗方案的不同分为2组:17例患者采用下肢骨折轴向牵引器辅助治疗(牵引器组),男12例,女5例;年龄(50.8±14.7)岁;骨折Schatzker分型:Ⅴ型8例,Ⅵ型9例。14例患者不使用撑开器而使用手法牵引辅助治疗(手法组),男9例,女5例;年龄(48.9±9.5)岁;骨折Schatzker分型:Ⅴ型6例,Ⅵ型8例。记录并比较两组患者的手术时间、术中出血量、末次随访时膝关节功能Rasmussen评分及胫骨近端内侧角等数据。结果牵引器组和手法组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。牵引器组和手法组患者分别获平均9.8、10.9个月随访。所有患者均获骨性愈合。牵引器组与手法组的手术时间分别为(127.8±40.8)、(174.1±66.8)min,出血量分别为(115.6±41.7)、(184.3±91.4)mL,以上项目两组间比较差异均有统计学意义(P<0.05)。牵引器组患者的膝关节屈曲活动度为126.1°±9.3°、胫骨近端内侧角为87.8°±1.4°、后倾角为8.7°±3.8°、末次随访时膝关节功能Rasmussen评分为(26.5±2.9)分,手法组患者的膝关节屈曲活动度为124.7°±8.9°、胫骨近端内侧角为86.9°±2.1°、后倾角为9.8°±4.1°、末次随访时膝关节功能Rasmussen评分为(25.6±3.2)分,以上项目两组间比较差异均无统计学意义(P>0.05)。末次随访时所有患者骨折部位均未见力线丢失。结论与传统手法复位相比,使用下肢骨折轴向牵引器辅助MIPO技术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折,能有效缩短手术时间,减少出血量,便于骨折块复位。ObjectiveTo investigate the clinical efficacy of minimally invasive plate oseoynthesis (MIPO) assisted by a self-designed lower limb axial tractor in the treatment of complex tibial plateau fractures.MethodsThe data were retrospectively analyzed of the 31 patients who had undergone surgical treatment for complex tibial plateau fractures from June 2015 to April 2018 at Department of Orthopeadics, Hospital Affiliated to Binzhou Medical College. MIPO was conducted with the assistance of the axial tractor in 17 of them. They were 12 men and 5 women with an age of 50.8±14.7 years, with 8 cases of Schatzker type Ⅴ and 9 ones of Schatzker type Ⅵ. MIPO was conducted without the assistance of the axial tractor but with the assistance of manipulation reduction in the other 14 patients. They were 9 men and 5 women with an age of 48.9±9.5 years, with 6 cases of Schatzker type Ⅴ and 8 ones of Schatzker type Ⅵ. The 2 groups were compared in terms of operation time, intraoperative bleeding, and Rasmussen scores for knee function and medial angle of the proximal tibia at the last follow-up.ResultsThe 2 groups were comparable due to insignificant differences in the preoperative general data between them (P>0.05). The tractor and manipulation groups were followed up for a mean of 9.8 months and 10.9 months respectively. Bone healing was achieved in all patients. For the tractor and manipulation groups, respectively, the operation time was127.8±40.8 min and 174.1±66.8 min, and the intraoperative bleeding 115.6±41.7 mL and 184.3±91.4 mL, showing significant differences between them (P<0.05). In the tractor group at the last follow-up, the knee flexion was 126.1°±9.3°, the medial angle of the proximal tibial 87.8°±1.4°, the posterior inclination angle 8.7°±3.8° and the Rasmussen score 26.5±2.9 points;in the manipulation group at the final follow-up, the knee flexion was 124.7°±8.9°, the medial angle of the proximal tibial 86.9°±2.1°, the posterior inclination angle 9.8°±4.1° and the Rasmussen score 25

关 键 词：膝关节 骨折固定术 内 外科手术 微创性 牵引器 胫骨平台骨折 

分 类 号：R68[医药卫生—骨科学]