两种不同手术方式治疗胫骨远端骨折疗效比较  

A comparative study of the efficacies of two different surgical methods for the treatment of distal tibial fractures

作　　者：尹进 陈明 王加飞 郑红兵 杨光辉 YIN Jin;CHEN Ming;WANG Jia-fei;ZHENG Hong-bing;YANG Guang-hui(Department of Orthopedics,Suqian Hospital Affiliated to Xuzhou Medical University/Suqian Hospital of Nanjing Drum Towel Hospital Group,Suqian Jiangsu 223800,China)

机构地区：[1]徐州医科大学附属宿迁医院/南京鼓楼医院集团宿迁医院骨科,江苏宿迁223800

出　　处：《局解手术学杂志》2024年第9期759-763,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：江苏省重点研发计划(BE2019703);宿迁市指导性科技计划(Z2022045)。

摘　　要：目的比较逆行胫骨髓内钉(RTN)与经皮微创接骨板(MIPPO)治疗胫骨远端骨折的疗效。方法回顾性分析于我院就诊并行手术治疗的55例胫骨远端骨折患者的临床资料,根据手术方式的不同将患者分为2组,RTN组(n=25)采用RTN治疗,MIPPO组(n=30)采用MIPPO治疗。比较2组患者手术相关参数(手术时间、术中出血量、术中透视次数及闭合复位成功率)、骨折愈合时间、术后6个月及末次随访时踝关节背伸活动度及美国足踝外科协会(AOFAS)踝-后足评分、围术期及随访期间并发症发生率。结果RTN组患者手术时间、术中出血量及术中透视次数均明显短/少于MIPPO组(P<0.05)。术后6个月RTN组患者踝关节背伸活动度及AOFAS踝-后足评分大/高于MIPPO组(P<0.05),2组患者骨折愈合时间、末次随访时踝关节背伸活动度和AOFAS踝-后足评分比较差异无统计学意义(P>0.05)。RTN组患者的闭合复位成功率为72.00%,低于MIPPO组的96.67%(P<0.05)。RTN组患者软组织相关并发症发生率明显低于MIPPO组(P<0.05),而2组患者总体并发症发生率比较差异无统计学意义(P>0.05)。结论RTN是治疗胫骨远端骨折的有效微创术式,与MIPPO相比,其具有创伤小、软组织并发症发生率低、关节功能恢复快的特点。Objective To compare the efficacies of retrograde tibial nailing(RTN)versus minimally invasive percutaneous plate osteosynthesis(MIPPO)in the treatment of distal tibial fractures.Methods A retrospective analysis was conducted on the clinical data of 55 patients with distal tibial fractures who underwent surgery in our hospital.Patients were divided into two groups based on the different surgical methods,patients in the RTN group(n=25)were treated with RTN,and patients in the MIPPO group(n=30)were treated with MIPPO.The surgical parameters(operation time,intraoperative blood loss,intraoperative fluoroscopy times,and success rate of closed reduction),fracture healing time,ankle dorsiflexion range of motion and American Orthopaedic Foot and Ankle Society(AOFAS)ankle�hindfoot scores 6 months after operation and at the last follow-up,and the incidence of complications during perioperative period and follow-up were compared between the two groups.Results The operation time,intraoperative blood loss,and intraoperative fluoroscopy times in the RTN group were significantly shorter/less than those in the MIPPO group(P<0.05).The ankle dorsiflexion range of motion and AOFAS ankle-hindfoot score 6 months after operation in the RTN group were significantly greater/higher than those in the MIPPO group(P<0.05).There was no statistically significant difference in the fracture healing time,or ankle dorsiflexion range of motion and AOFAS ankle-hindfoot score at the last follow-up between the two groups(P>0.05).The success rate of closed reduction in the RTN group was 72.00%,which was lower than that of 96.67%in the MIPPO group(P<0.05).The incidence of soft tissue-related complications in the RTN group was significantly lower than that in the MIPPO group(P<0.05),while there was no statistically significant difference in the overall incidence of complications between the two groups(P>0.05).Conclusion RTN is an effective minimally invasive surgical technique for the treatment of distal tibial fractures,characterized by minimal traum

关 键 词：胫骨远端骨折 逆行胫骨髓内钉 经皮微创接骨板 

分 类 号：R683.42[医药卫生—骨科学]