下肢骨折轴向牵引器辅助MIPO治疗复杂型胫骨平台骨折效果分析  

Effect of axial traction device for lower limb fractures assisted by MIPO in the treatment of complex tibial plateau fractures

作　　者：马国涛[1] 贾科江 杨朝垒[1] 宋志勇 Ma Guotao;Jia Kejiang;Yang Chaolei;Song Zhiyong(Department of Orthopedics,Pingdingshan First People's Hospital,Pingdingshan,Henan 467000,China)

机构地区：[1]平顶山市第一人民医院骨科,河南平顶山467000

出　　处：《创伤外科杂志》2021年第10期749-752,756,共5页Journal of Traumatic Surgery

基　　金：河南省科技攻关项目(2018ZY2112)。

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)治疗复杂型胫骨平台骨折的效果。方法前瞻性研究2018年3月—2020年1月平顶山市第一人民医院骨科收治复杂型胫骨平台骨折患者90例,男性56例,女性34例;年龄18~65岁,平均43.0岁。道路交通伤49例,跌倒伤26例,砸伤15例。根据随机数字表法分为A、B两组,各45例。A组行MIPO联合下肢骨折轴向牵引器辅助治疗,B组行MIPO联合传统手法牵引切开复位辅助治疗。A组男性29例,女性16例;年龄18~63岁,平均42.4岁;跌倒伤14例,道路交通伤24例,砸伤7例。B组男性27例,女性18例;年龄18~65岁,平均43.5岁;跌倒伤12例,道路交通伤25例,砸伤8例。比较两组患者相关手术指标、患肢解剖学指标、膝关节运动学指标、膝关节功能、术后并发症情况。结果A组术中出血量、手术时间(119.2±20.3)mL、(121.7±18.4)min显著少于B组(171.2±29.5)mL、(180.1±30.7)min,P<0.05;A、B组术后6个月胫骨近端内侧角分别为(86.3±15.4)°、(87.1±16.1)°,胫骨近端后倾角分别为(8.9±1.4)°、(9.1±1.6)°,差异均无统计学意义(P>0.05)。A、B组术后6个月膝关节最大屈曲度分别为(126.6±19.8)°、(123.3±20.0)°,股骨内髁后移幅度分别为(2.1±0.4)mm、(2.2±0.3)mm,股骨外髁后移幅度分别为(7.2±1.1)mm、(7.3±1.3)mm,差异均无统计学意义(P>0.05)。A、B组术后6个月膝关节协会评分(KSS)的关节性评分分别为(90.1±16.2)分、(92.9±17.4)分,KSS功能性评分分别为(92.7±15.8)分、(91.6±16.2)分,差异均无统计学意义(P>0.05)。A组切口浅表感染1例;B组切口浅表感染3例、下肢深静脉血栓形成1例、内侧副韧带不稳定2例;A组总并发症发生率(2%)低于B组(13%),P<0.05。结论应用MIPO治疗复杂型胫骨平台骨折时,下肢骨折轴向牵引器辅助治疗与传统手法牵引切开复位辅助治疗均可有效改善患者患肢膝关节功能,但前者能有效缩短手术时间、减少术中出血量�Objective To explore the effect of axial traction device for lower limb fractures assisted by minimally invasive plate osteosynthesis(MIPO)in the treatment of complex tibial plateau fractures.Methods The clinical data of patients with plateau fractures included 56 males and 34 females;they were 18-65 years old,with an average of 43.0 years old.There were 49 cases of road traffic injuries,26 cases of falling injuries,and 15 cases of crush injuries.According to the random number table method,they were divided into group A and group B,with 45 cases in each group.Group A was treated with MIPO combined with axial traction device for lower limb fractures,and group B was treated with MIPO combined with traditional manual traction open reduction.In group A,there were 29 males and 16 females,with an average of 42.44 years(range,18-63 years);there were 14 cases of falling injuries,24 cases of road traffic injuries,and 7 cases of crush injuries.In group B,there were 27 males and 18 females,with an average age of 43.53 years(range,18-65 years).There were 12 cases of falling injuries,25 cases of road traffic injuries,and 8 cases of crush injuries.The related surgical indicators,anatomical indicators of the affected limb,knee kinematics indicators,knee joint function,and postoperative complications were compared between the two groups.Results The intraoperative blood loss and operation time of group A were(119.2±20.3)mL and(121.7±18.4)minutes,which were significantly less than those in group B of(171.2±29.5)mL and(180.1±30.7)minutes,respectively,P<0.05.The medial angles of the proximal tibia in groups A and B were(86.3±15.4)°and(87.1±16.1)°at 6 months postoperatively,the posterior inclination angles of the proximal tibia were(8.9±1.4)°and(9.1±1.6)°,and the difference was not statistically significant(P>0.05).The maximum flexion of the knee joint in groups A and B were(126.6±19.8)°and(123.3±20.0)°at 6 months after surgery,the posterior displacement of the femoral medial condyle were(2.2±0.4)mm and(2.2±0.4)mm,a

关 键 词：胫骨平台骨折 微创 接骨板 牵引器 

分 类 号：R683.42[医药卫生—骨科学]