复杂胫骨平台骨折微创钢板接骨术与常规术式比较  

Comparison of minimally invasive plate osteosynthesis versus conventional open reduction and internal fixation with plate for complex tibial plateau fractures

作　　者：沈锋[1] 万杰 魏国文[1] 吴小海[1] SHEN Feng;WAN Jie;WEI Guo-wen;WU Xiao-hai(Department of Orthopedics,Nanchang First Hospital,Nanchang 330008,China)

机构地区：[1]南昌市第一医院骨科,江西南昌330008

出　　处：《中国矫形外科杂志》2021年第18期1653-1657,共5页Orthopedic Journal of China

摘　　要：[目的]比较微创钢板接骨术(minimally invasive plate osteosynthesis, MIPO)与常规开放复位内固定(open reduction and internal fixation with plate, ORIF)治疗复杂胫骨平台骨折的临床疗效。[方法] 2017年9月—2019年9月,共84例胫骨平台骨折患者纳入本研究,采用随机数字表法分为两组。其中,42例采用MIPO技术,另外42例采用常规ORIF。比较两组围手术期、随访和影像资料。[结果]两组均顺利完成手术,术中无神经、血管损伤等严重并发症。MIPO组手术时间、切口总长度、术中出血量、住院时间均显著优于ORIF组(P<0.05),但是MIPO组术中透视次数显著多于ORIF组(P<0.05)。两组患者均获随访18~42个月,平均(32.16±6.98)个月。MIPO组恢复下地行走和完全负重活动时间均显著早于ORIF组(P<0.05)。随术后时间推移,两组患者VAS评分显著减少(P<0.05),而Lysholm评分和ROM显著增加(P<0.05);术后3个月时,MIPO组在VAS、Lysholm评分和ROM均显著优于ORIF组(P<0.05),但是末次随访时,两组间VAS、Lysholm评分和ROM的差异均已无统计学意义(P>0.05)。影像方面,两组骨折复位质量的差异无统计学意义(P>0.05),术后两组间MPTA和PTS的差异无统计学意义(P>0.05)。但是,MIPO组骨折影像愈合显著早于ORIF组(P<0.05)。[结论]相比常规ORIF术,钢板的MIPO技术可显著减少医源性损伤,更有利于骨折愈合和功能恢复。[Objective] To compare the clinical efficacy of minimally invasive plate osteosynthesis(MIPO) versus conventional open reduction and internal fixation with plate(ORIF) for complex tibial plateau fractures. [Methods] From September 2017 to September 2019, a total of 84 patients with complex tibial plateau fractures were included in the study and were divided into two groups by using a random number table method. Among them, 42 patients received MIPO, while the other 42 patients underwent conventional ORIF. The perioperative, follow-up and radiographic documents were compared between the two groups. [Results] All the patients in both groups had operation finished successfully without serious complications such as nerve and blood vessel damages. The MIPO group was significantly superior to the ORIF group in terms of operation time, total incision length, intraoperative blood loss, and hospital stay(P<0.05), but the former had significantly greater number of intraoperative fluoroscopy than the latter(P<0.05). The patients in both groups were followed up for 18~42 months, with an average of(32.16±6.98) months. The MIPO group resumed walking and full weight bearing activity significantly earlier than the ORIF group(P<0.05). The VAS score decreased significantly(P<0.05), while the Lysholm score and ROM increased significantly in both groups over time postoperatively(P<0.05). At 3 months after operation, the MIPO group was proved significantly superior to the ORIF group in VAS, Lysholm score and ROM(P<0.05), whereas which became not statistically significant in term of abovesaid parameters between the two groups at the latest follow-up(P>0.05). Regarding to radiographic assessment, there was no a statistically significant difference in the quality of fracture reduction(P>0.05), and no differences in medial proximal tibial angle(MPTA) and posterior tibial slope(PTS) between the two groups after surgery(P>0.05). However, the MIPO group got bony healing on images significantly earlier than the ORIF group(P<0.05). [Conclusi

关 键 词：复杂胫骨平台 微创钢板接骨术(MIPO) 传统开放复位钢板内固定(ORIF) 

分 类 号：R683.42[医药卫生—骨科学]