闭合复位半环形外固定架与微创经皮钢板内固定治疗胫骨中下段骨折的疗效比较  

Comparison of clinical efficacy between closed reduction combined with semi-circular external fixator and minimally invasive percutaneous plate osteosynthesis(MIPPO)in the treatment of middle and distal tibia fractures

作　　者：伏敏睿 史长龙[1] 高景华[1] 李路广 李建国 成永忠[1] 吴钟凯[1] FU Min-rui;SHI Chang-long;GAO Jing-hua;LI Lu-guang;LI Jian-guo;CHENG Yong-zhong;WU Zhong-kai(Wangjing Hospital of China Academy of Chinese Medical Sciences,Beijing100102,China)

机构地区：[1]中国中医科学院望京医院,北京100102

出　　处：《中国骨伤》2023年第9期815-820,共6页China Journal of Orthopaedics and Traumatology

基　　金：北京市科技计划课题(编号:Z211100002921021)。

摘　　要：目的:比较闭合复位、弯针配合半环形外固定架与微创经皮钢板内固定(minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗胫骨中下段骨折的临床疗效。方法:回顾性分析2019年1月至2022年11月收治的60例胫骨中下段骨折患者,分为外固定组和内固定组,各30例。外固定组男18例,女12例;年龄(49.29±2.35)岁;左侧14例,右侧16例;采用闭合复位、弯针配合半环形外固定架治疗。内固定组男20例,女10例;年龄(48.96±1.87)岁;左侧15例,右侧15例;采用MIPPO治疗。治疗前后观察并比较两组患者相关指标,包括受伤至手术时间、手术时长、切口长度、术中出血量、主动活动时间和切口愈合等级等围手术期资料,Johner-Wruhs评分,最小疼痛完全负重时间,疼痛视觉模拟评分(visual analogue scale,VAS),SF-36量表和并发症,比较两组临床疗效。结果:外固定组切口长度(1.36±0.86)cm和术中出血量(10.83±5.73)ml,优于内固定组的切口长度(12.74±3.12)cm及出血量(86.47±8.90)ml(P<0.05)。两组患者随访时间(6.23±1.89)个月。外固定组术后开始主动活动时间(1.50±0.54)d和最小疼痛完全负重活动时间(108.87±3.43)d,晚于内固定组开始主动活动时间(1.15±0.98)d和最小疼痛完全负重活动时间(105.27±3.68)d(P<0.05)。随术后时间推移,两组SF-36量表评分均逐渐增加,VAS均逐渐降低,术后1、6、3个月两组VAS及SF-36量表评分差异无统计学意义(P>0.05)。术中手术时间外固定组(35.42±9.31)min,短于内固定组(74.22±7.81)min(P<0.05)。术中均无血管神经损伤,术后皮肤坏死外固定组为0例,内固定组为6例,差异有统计学意义(P<0.05)。结论:外固定架与钢板内固定均为治疗胫骨中下段骨折的较好方法,外固定架固定具有手术创伤小、并发症少的优势。Objective To compare the clinical efficacy between closed reduction combined with semi-circular external fixator and minimally invasive percutaneous plate osteosynthesis(MIPPO)in the treatment of middle anddistal tibia fractures.Methods The clinical data of sixty patients with middle and distal tibia fractures admitted between January 2019 and November 2022,were retrospectively analyzed.These patients were categorized into external fixation group(n=30)and internal fixation group(n=30).There were 18 males and 12 females in the external fixation group,with an average age of(49.29±2.35)years old.Among them,14 patients presented with fractures on the left side,and 16 patients presented with fractures on the right side.Closed reduction,arched wire,and semi-circular external fixator were used for treatment.There were 20 males and 10 females in the internal fixation group,with an average age of(48.96±1.87)years old.Among them,15 patients presented with fractures on the left side,and 15 patients presented with fractures on the right side.MIPPO technique was used for the treatment.Perioperative parameters,including time injury to surgery,surgical duration,incision length,intraoperative bleeding,time to active activity,and incision healing level,were compared between the two groups.Clinical outcomes were also assessed,including Johner-Wruhs scores,time to minimum pain-adapted full weight-bearing,visual analog scale(VAS),SF-36 scale,and complications.Results The external fixation group exhibited a significantly shorter incision length(1.36±0.86)cm and lower intraoperative bleeding(10.83±5.73)ml compared to the internal fixation group(12.74±3.12)cm and(86.47±8.90)ml,respectively(P<0.05).The postoperative active activity time(1.50±0.54)days and minimum pain-adapted full weight-bearing activity time(108.87±3.43)days in the external fixation group were slightly delayed than the internal fixation group(1.15±0.98)days and(105.27±3.68)days,respectively(P<0.05).Over a mean postoperative follow-up duration of(6.23±1.89)mo

关 键 词：胫骨骨折 外固定架 钢板内固定 回顾性分析 

分 类 号：R683[医药卫生—骨科学]