微创解剖锁定钢板结合同位螺钉治疗胫腓骨下段骨折的疗效观察
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摘要
目的探讨微创解剖锁定钢板结合同位螺钉治疗胫腓骨下段骨折的疗效。方法对46例胫腓骨下段骨折患者按照治疗方法,分为观察组21例,采用微创解剖锁定钢板结合同位螺钉治疗,对照组25例,采用单纯微创解剖锁定钢板治疗。记录所有患者影像学愈合时间、临床愈合时间、半年愈合率、患肢功能Johner-Wruhs评分和并发症情况。结果患者均获得随访,时间9~34个月。观察组影像学及临床愈合时间分别为(46.57±14.51)d、(86.27±19.35)d,明显低于对照组(61.18±18.25)d、(112.84±24.46)d,差异有统计学意义(P<0.05)。观察组半年愈合率95.24%,与对照组84%相比,差异无统计学意义(P>0.05)。观察组、对照组患肢Johner-Wruhs功能优良率分别为85.71%、80%,差异无统计学意义(P>0.05)。观察组、对照组并发症发生率分别为23.81%、16%,差异无统计学意义(P>0.05)。结论微创解剖锁定钢板结合同位螺钉治疗胫腓骨下段骨折安全性高,能够促进骨折愈合,值得临床推广应用。
Objective To explore the efficacy of minimally invasive anatomical locking plate combined with appositional screws in the treatment of distal tibia and fibula fractures. Methods Forty-six patients with distal tibia and fibula fractures were divided into observation group( n = 21) and control group( n = 25)according to the treatment. The observation group and the control group underwent minimally invasive anatomical locking plate combined with the appositional screw and simple minimally invasive anatomical locking plate respectively. The related indices were recorded,including duration for radiological healing and clinical healing,six-month healing rate,Johner-Wruhs score of affected limb function and complications.Results All the patients were followed up for 9-34 months. The duration for radiological and clinical healing in the observation group [( 46. 57 ± 14. 51) d and( 86. 27 ± 19. 35) d respectively]were significantly shorter than those of the control group [( 61. 18 ± 18. 25) d and( 112. 84 ± 24. 46) d respectively]( P < 0. 05). There was no significant difference in the six-month healing rate between the observation group and the control group( 5. 24% vs. 84%,P > 0. 05). There was no significant difference in the excellent and good rate of Johner-Wruhs function for affected limbs between the observation group and the control group( 85. 71% vs.80%,P > 0. 05). There was no significant difference in the incident rate of complications between the observation group and the control group( 23. 81% vs. 16%,P > 0. 05). Conclusion For distal tibia and fibula fracture,minimally invasive anatomical locking plate combined with appositional screws is safe,can promote fracture healing,and is worthy of clinical promotion and application.
Objective To explore the efficacy of minimally invasive anatomical locking plate combined with appositional screws in the treatment of distal tibia and fibula fractures. Methods Forty-six patients with distal tibia and fibula fractures were divided into observation group( n = 21) and control group( n = 25)according to the treatment. The observation group and the control group underwent minimally invasive anatomical locking plate combined with the appositional screw and simple minimally invasive anatomical locking plate respectively. The related indices were recorded,including duration for radiological healing and clinical healing,six-month healing rate,Johner-Wruhs score of affected limb function and complications.Results All the patients were followed up for 9-34 months. The duration for radiological and clinical healing in the observation group [( 46. 57 ± 14. 51) d and( 86. 27 ± 19. 35) d respectively]were significantly shorter than those of the control group [( 61. 18 ± 18. 25) d and( 112. 84 ± 24. 46) d respectively]( P < 0. 05). There was no significant difference in the six-month healing rate between the observation group and the control group( 5. 24% vs. 84%,P > 0. 05). There was no significant difference in the excellent and good rate of Johner-Wruhs function for affected limbs between the observation group and the control group( 85. 71% vs.80%,P > 0. 05). There was no significant difference in the incident rate of complications between the observation group and the control group( 23. 81% vs. 16%,P > 0. 05). Conclusion For distal tibia and fibula fracture,minimally invasive anatomical locking plate combined with appositional screws is safe,can promote fracture healing,and is worthy of clinical promotion and application.
引文
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[8]刘征,田学东.150例四肢长骨干骨折内固定术后钢板断裂原因分析[J].中国骨与关节损伤杂志,2017,32(9):998-999.
[9]杨坚,穆亮,王维山.胫前减张切口结合锁定加压钢板治疗老年胫腓骨远端骨折的临床疗效[J].中国老年学杂志,2015,35(5):1298-1299.
[2]韩立仁,赵北,穆卫东,等.外固定架加钢板治疗伴有胫骨骨缺损的开放性胫腓骨骨折[J].中华创伤杂志,2013,29(3):258-261.
[3]张发平,何罗彬,罗仕武,等.微创经皮锁定钢板内固定治疗胫腓骨骨折疗效评价[J].实用骨科杂志,2014,20(1):26-28.
[4]Wang C,Chen E,Ye C,et al.Suprapatellar versus infrapatellar approach for tibia intramedullary nailing:A meta-analysis[J].Int J Surg,2018,51:133-139
[5]Strelzow J,Aarvold A,Reilly CW.Triplane Fracture of the Proximal Tibia:A Case Report and Literature Review[J].Case Rep Orthop,2017,2017:6490728.
[6]zku B,Saygili MS,Cetinkaya E,et al.Angular deformity development after the distal tibial physeal fractures[J].Acta Orthop Belg,2016,82(4):814-820.
[7]Oken OF,Yildirim AO,Asilturk M.Finite element analysis of the stability of AO/OTA 43-C1 type distal tibial fractures treated with distal tibia medial anatomic plate versus anterolateral anatomic plate[J].Acta Orthop Traumatol Turc,2017,51(5):404-408.
[8]刘征,田学东.150例四肢长骨干骨折内固定术后钢板断裂原因分析[J].中国骨与关节损伤杂志,2017,32(9):998-999.
[9]杨坚,穆亮,王维山.胫前减张切口结合锁定加压钢板治疗老年胫腓骨远端骨折的临床疗效[J].中国老年学杂志,2015,35(5):1298-1299.