闭合复位静态交锁髓内钉内固定与MIPPO技术结合锁定加压钢板治疗胫骨远端骨折临床效果对照研究
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摘要
目的探讨闭合复位静态交锁髓内钉内固定与微创经皮钢板接骨术(MIPPO)结合锁定加压钢板(LCP)治疗对胫骨远端骨折患者围术期指标、骨折愈合时间及术后并发症的影响。方法我院160例胫骨远端骨折患者,根据治疗方法不同分为A组(闭合复位静态交锁髓内钉内固定)和B组(MIPPO结合LCP),比较两组围术期指标、骨折愈合时间、术后并发症以及膝关节、踝关节功能恢复情况。结果 A组手术时间、透视时间低于B组,术中出血量高于B组(P <0. 05);两组临床愈合及骨折愈合时间比较差异无统计学意义(P> 0. 05); A组发生并发症14例(13. 46%),B组发生并发症4例(7. 14%),差异无统计学意义(P> 0. 05);两组术后膝关节功能评分逐渐升高,不同时间点比较差异有统计学意义(P <0. 05),A组术后3、6个月膝关节功能评分低于B组(P <0. 05);两组术后踝关节功能评分逐渐升高,不同时间点比较差异有统计学意义(P <0. 05),两组相同时间比较差异无统计学意义(P> 0. 05)。结论闭合复位静态交锁髓内钉内固定与MIPPO结合LCP治疗均为胫骨远端骨折有效方法,两者临床效果相当,但各有优势和不足,需根据患者病情和当地医疗条件合理选择手术方案。
Objective To investigate the effects of closed reduction with static interlocking intramedullary nail internal fixation and minimally invasive percutaneous plate osteosynthesis( MIPPO) with locking compression plate( LCP) on the perioperative indexes,fracture healing time and postoperative complications in patients with distal tibial fractures.Methods The clinical data of 160 patients with distal tibial fractures in our hospital were retrospectively analyzed.The patients were divided into group A( closed reduction with static interlocking intramedullary nail internal fixation) and group B( MIPPO with LCP) according to different treatment methods.The perioperative indexes,fracture healing time,postoperative complications,and recovery of knee and ankle joint function were compared between the two groups.Results The operative time and fluoroscopy time in the group A were shorter but the intraoperative blood loss was larger than those in the group B( P < 0. 05).There was no significant difference in clinical healing and fracture healing time between the two groups( P > 0. 05).There were 14 cases( 13. 46%) in the group A and 4 cases( 7. 14%) in the group B with complications,but this did not reach significant difference( P > 0. 05).The score of knee function was gradually recovered after operation,and the difference was statistically significant at different time points( P < 0. 05).The knee function scores at 3 months and 6 months after operation in the group A were lower than those in the group B( P < 0. 05).The score of ankle function was gradually increased in the two groups after operation,and the difference was statistically significant at different time points( P < 0. 05),and there was no significant difference between the two groups at the same time points( P > 0. 05).Conclusion The two methods are effective for distal tibial fractures with similar clinical outcome.However,each has its own advantages and disadvantages. Therefore,it is necessary to rationally select an operation plan according to the patient's status and local medical conditions.
Objective To investigate the effects of closed reduction with static interlocking intramedullary nail internal fixation and minimally invasive percutaneous plate osteosynthesis( MIPPO) with locking compression plate( LCP) on the perioperative indexes,fracture healing time and postoperative complications in patients with distal tibial fractures.Methods The clinical data of 160 patients with distal tibial fractures in our hospital were retrospectively analyzed.The patients were divided into group A( closed reduction with static interlocking intramedullary nail internal fixation) and group B( MIPPO with LCP) according to different treatment methods.The perioperative indexes,fracture healing time,postoperative complications,and recovery of knee and ankle joint function were compared between the two groups.Results The operative time and fluoroscopy time in the group A were shorter but the intraoperative blood loss was larger than those in the group B( P < 0. 05).There was no significant difference in clinical healing and fracture healing time between the two groups( P > 0. 05).There were 14 cases( 13. 46%) in the group A and 4 cases( 7. 14%) in the group B with complications,but this did not reach significant difference( P > 0. 05).The score of knee function was gradually recovered after operation,and the difference was statistically significant at different time points( P < 0. 05).The knee function scores at 3 months and 6 months after operation in the group A were lower than those in the group B( P < 0. 05).The score of ankle function was gradually increased in the two groups after operation,and the difference was statistically significant at different time points( P < 0. 05),and there was no significant difference between the two groups at the same time points( P > 0. 05).Conclusion The two methods are effective for distal tibial fractures with similar clinical outcome.However,each has its own advantages and disadvantages. Therefore,it is necessary to rationally select an operation plan according to the patient's status and local medical conditions.
引文
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[9]王涛,雷正民,谢宇鹏.经皮内侧解剖型锁定钢板治疗胫骨远端骨折[J].中国药物与临床,2016,16(6):883-884.
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[11]马腾,王谦,路遥,等.闭合复位髓内钉固定胫骨骨折术中远端是否存在内外翻的判断[J].中华创伤骨科杂志,2016,18(7):553-557.
[12]郑立槟,吴轲,袁立仁,等.动力与静力交锁髓内钉内固定治疗成年新鲜股骨干骨折的比较研究[J].中国骨与关节损伤杂志,2015,30(6):589-591.
[13]仇志学,王明远,车晓明,等.微创经皮钢板接骨术治疗高能量胫骨干骨折的临床疗效[J].现代生物医学进展,2016,16(17):3314-3316.
[14]王鉴顺,吴信雷,郭晓山.非锁定加压钢板与锁定加压钢板固定肱骨干骨折的有限元分析[J].中华创伤骨科杂志,2016,18(4):336-340.
[15]李永甫,贺振年,郭剑,等.股骨干骨折完全闭合复位与小切口闭合复位标准髓内固定手术疗效分析[J].中国急救医学,2016,36(z2):56-57.
[16]陈刚,钱明权,朱国兴,等.经皮闭合复位锁定钢板和交锁髓内钉及切开复位钢板置入修复胫骨中下段骨折:生物稳定性比较[J].中国组织工程研究,2014,21(44):7151-7156.
[17]徐宏文,梅海波,郭跃明,等.发育性髋关节脱位闭合复位术后残留髋臼发育不良手术指证及时机的回顾性多中心研究[J].中华小儿外科杂志,2016,37(12):883-887.
[18]沈素红,王孝辉,付卓,等.超声引导下闭合复位微创固定治疗掌指骨骨折[J].中国医学影像技术,2018,34(2):293-296.
[19]陈昌博,鲁道海.经皮锁定加压钢板固定与交锁髓内钉固定治疗胫骨远端关节外骨折效果对比观察[J].山东医药,2016,56(44):86-88.
[20]杨蓊勃,吴磊,尹昭伟,等.闭合复位经第四掌骨平行克氏针内固定治疗第五掌骨颈骨折[J].中华手外科杂志,2017,33(5):327-329.
[2]韩福胜,杨文珍,刘宝勋,等.三种不同方法治疗胫骨远端骨折的临床综合疗效比较[J].河北医药,2016,38(11):1697-1699.
[3]柴明祥,赵斌,张文武,等.三种固定方法治疗AO分型43-A型胫骨骨折的疗效比较[J].中华创伤骨科杂志,2016,18(7):579-585.
[4]高金伟,吴斗.金属植入物固定与修复新鲜不稳定型桡骨远端骨折合并腕舟状骨骨折:半年随访[J].中国组织工程研究,2016,20(13):1880-1887.
[5]吴敏,官建中,肖玉周,等.钢板联合皮质外骨桥技术治疗肱骨干骨折术后萎缩性骨不连[J].中国修复重建外科杂志,2017,31(1):1-4.
[6]马云兵,曹有良,王俊波,等.临时关节型抗生素骨水泥占位器治疗人工髋关节置换术后感染30例临床分析[J].中华实用诊断与治疗杂志,2016,30(12):1196-1198.
[7]杨国跃,江汉,刘智,等.跟腱旁后内侧入路治疗HaraguchiⅡ型后踝骨折[J].中华骨科杂志,2016,36(21):1348-1354.
[8]张小龙,李皓桓.胫骨平台骨折的手术治疗[J].生物骨科材料与临床研究,2017,14(4):58-62.
[9]王涛,雷正民,谢宇鹏.经皮内侧解剖型锁定钢板治疗胫骨远端骨折[J].中国药物与临床,2016,16(6):883-884.
[10]夏韶襁,刘世清.髓内钉治疗成人肱骨干骨折的研究进展[J].骨科,2016,7(3):222-224.
[11]马腾,王谦,路遥,等.闭合复位髓内钉固定胫骨骨折术中远端是否存在内外翻的判断[J].中华创伤骨科杂志,2016,18(7):553-557.
[12]郑立槟,吴轲,袁立仁,等.动力与静力交锁髓内钉内固定治疗成年新鲜股骨干骨折的比较研究[J].中国骨与关节损伤杂志,2015,30(6):589-591.
[13]仇志学,王明远,车晓明,等.微创经皮钢板接骨术治疗高能量胫骨干骨折的临床疗效[J].现代生物医学进展,2016,16(17):3314-3316.
[14]王鉴顺,吴信雷,郭晓山.非锁定加压钢板与锁定加压钢板固定肱骨干骨折的有限元分析[J].中华创伤骨科杂志,2016,18(4):336-340.
[15]李永甫,贺振年,郭剑,等.股骨干骨折完全闭合复位与小切口闭合复位标准髓内固定手术疗效分析[J].中国急救医学,2016,36(z2):56-57.
[16]陈刚,钱明权,朱国兴,等.经皮闭合复位锁定钢板和交锁髓内钉及切开复位钢板置入修复胫骨中下段骨折:生物稳定性比较[J].中国组织工程研究,2014,21(44):7151-7156.
[17]徐宏文,梅海波,郭跃明,等.发育性髋关节脱位闭合复位术后残留髋臼发育不良手术指证及时机的回顾性多中心研究[J].中华小儿外科杂志,2016,37(12):883-887.
[18]沈素红,王孝辉,付卓,等.超声引导下闭合复位微创固定治疗掌指骨骨折[J].中国医学影像技术,2018,34(2):293-296.
[19]陈昌博,鲁道海.经皮锁定加压钢板固定与交锁髓内钉固定治疗胫骨远端关节外骨折效果对比观察[J].山东医药,2016,56(44):86-88.
[20]杨蓊勃,吴磊,尹昭伟,等.闭合复位经第四掌骨平行克氏针内固定治疗第五掌骨颈骨折[J].中华手外科杂志,2017,33(5):327-329.