MIPPO与超关节外固定支架对GustiloⅡ型开放胫骨远端骨折患者踝关节功能的影响  

The Influence of MIPPO and Super-Articular External Fixation on the Ankle Function of Patients with Gustilo TypeⅡOpen Distal Tibial Fracture

作　　者：刘岩 邢建飞 宋少峰 韩胜义 Liu Yan;Xing Jianfei;Song Shaofeng(Department of Orthopaedics,Zhangjiakou Second Hospital,Zhangjiakou 075000,China)

机构地区：[1]张家口市第二医院骨四科,河北张家口075000 [2]张家口市第一医院骨科,河北张家口075041

出　　处：《实用骨科杂志》2021年第6期506-511,共6页Journal of Practical Orthopaedics

摘　　要：目的对比分析微创经皮钢板内固定技术(minimally invasive percutaneous plate osteosynthesis,MIPPO)与超关节外固定支架治疗GustiloⅡ型开放胫骨远端骨折的临床效果,并探究两种手术对患者踝关节功能的影响。方法回顾性选取我院2018年1月至2020年1月122例GustiloⅡ型开放胫骨远端骨折患者,根据手术方案不同分为两组,各61例,A组采用MIPPO治疗,B组采用超关节外固定支架治疗。统计比较两组手术和术后恢复情况、踝关节功能恢复优良率、术后并发症发生率、患肢足背动脉血流动力学参数[收缩期峰值血流速度(systolic flow,SF)、舒张期峰值血流速度(diastolic flow,DF)、平均血流速度(time average maximum,TAM)、阻力指数(resistance index,RI)]、应激指标[降钙素原(procalcitonin,PCT)、白细胞介素-6(interleukin-6,IL-6)、前列腺素E2(prostaglandin E2,PGE2)、P物质(substance P,SP)]、疼痛视觉模拟评分(visual analogue scale,VAS)、Lowa踝关节评分。结果A组手术时间、肿胀消退时间、平均住院时间均短于B组(P<0.05);A组踝关节功能恢复优良率(95.08%)高于B组(81.97%),P<0.05;A组术后1 d、3 d、7 d血清PCT、IL-6、PGE2、SP水平均低于B组(P<0.05);A组术后1 d、3 d、7 d患肢足背动脉SF、DF、TAM均高于B组,RI低于B组(P<0.05);A组术后并发症总发生率(11.48%)与B组(9.84%)比较,差异无统计学意义(P>0.05);A组术后3个月、6个月、12个月运动VAS评分、静息VAS评分均低于B组,Lowa踝关节评分高于B组(P<0.05)。结论与超关节外固定支架比较,采用MIPPO治疗GustiloⅡ型开放胫骨远端骨折的临床效果更佳,可进一步改善踝关节功能恢复情况。Objective To compare and analyze the clinical effects of minimally invasive percutaneous plate osteosynthesis(MIPPO)and over-articular external fixation in the treatment of Gustilo typeⅡopen distal tibial fractures,and to explore the effects of the two operations on the patient's ankle joint function.Methods In this retrospective study,122 patients with Gustilo typeⅡopen distal tibial fractures in our hospital from January 2018 to January 2017 were divided into two groups according to different surgical plans.There were 61 cases in each group.Group A was treated with MIPPO,and group B was treated with super-articular external fixation.The operation and postoperative recovery,excellent and good rate of recovery of ankle joint function,incidence of postoperative complications and dorsal artery of the affected limbs[systolic flow(SF),diastolic flow(DF),time average maximum(TAM),resistance index(RI),stress index[procalcitonin(PCT),interleukin-6(IL-6),prostaglandin E2(PGE2),substance P(SP)],hemodynamic parameters of the pain degree and Lowa ankle score were compared between the two groups.Results The operation time,swelling subsided time,and average hospital stay in the A group were shorter than those in the B group(P<0.05).The excellent and good rate of recovery of ankle joint function in the A group(95.08%)was higher than that of the B group(81.97%),P<0.05.Serum levels of PCT,IL-6,PGE2,and SP in the A group were lower than those in the B group at 1,3,and 7 days after operation(P<0.05).The SF,DF and TAM of the dorsal foot arteries of the affected limbs in the A group were higher than those in the B group at 1,3,and 7 days after the operation,and the RI was lower than that in the B group(P<0.05).The total incidence of postoperative complications in the A group(11.48%)and the B group(9.84%)were not statistically different(P>0.05).The exercise VAS score and resting VAS score of the A group were lower than those of the B group at 3 months,6 months,and 12 months after the operation,and the Lowa ankle score was higher

关 键 词：胫骨远端骨折 超关节外固定支架 微创经皮钢板内固定术 踝关节功能 

分 类 号：R683.42[医药卫生—骨科学]