| 不同手术时机微创经皮钢板接骨术治疗胫骨远侧干骺端粉碎性骨折的病例对照研究 |
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投稿时间：2013-08-09
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| 作者 | Author | 单位 | Address | E-Mail |
| 李强 |
LI Qiang |
杭州市萧山区中医院骨三科, 浙江 杭州 311201 |
Department of Orthopaedics, Xiaoshan Hospital of TCM, Hangzhou 311201, Zhejiang, China |
xslq2007@163.com |
| 陈恩良 |
CHEN En-liang |
杭州市萧山区中医院骨三科, 浙江 杭州 311201 |
Department of Orthopaedics, Xiaoshan Hospital of TCM, Hangzhou 311201, Zhejiang, China |
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| 陈荣良 |
CHEN Rong-liang |
杭州市萧山区中医院骨三科, 浙江 杭州 311201 |
Department of Orthopaedics, Xiaoshan Hospital of TCM, Hangzhou 311201, Zhejiang, China |
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| 蒋大权 |
JIANG Da-quan |
杭州市萧山区中医院骨三科, 浙江 杭州 311201 |
Department of Orthopaedics, Xiaoshan Hospital of TCM, Hangzhou 311201, Zhejiang, China |
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| 期刊信息：《中国骨伤》2014年，第27卷，第6期，第508-512页 |
| DOI：10.3969/j.issn.1003-0034.2014.06.016 |
| 基金项目: |
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| 中文摘要:目的： 比较损伤早期与延期微创经皮钢板接骨术（minimally invasive percutaneous plate osteosynthesis，MIPPO）治疗胫骨远侧干骺端粉碎性骨折的临床效果。方法： 自2006年1月至2012年1月，采用MIPPO技术治疗闭合性胫骨远侧干骺端粉碎性骨折患者66例。根据手术时机将患者分为两组，早期手术组31例，男18例，女13例；年龄21～57岁，平均（39.0±17.8）岁；在损伤早期即实施MIPPO手术；其中Tscherne软组织损伤Ⅰ级18例，Ⅱ级12例，Ⅲ级例1例。延期手术组35例，男16例，女19例；年龄24～55岁，平均（39.5±15.2）岁；延期接受MIPPO手术；其中Tscherne软组织损伤Ⅰ级6例，Ⅱ级26例，Ⅲ级3例。记录并观察两组患者的手术时间、术中出血量、住院时间、骨折愈合时间及并发症等情况，末次随访时采用Lowa踝关节评分评价患者的功能疗效，采用正侧位X线片评估骨折复位维持及对线情况。结果： 两组患者均获随访，早期手术组随访（13.5±3.5）个月，延期手术组随访（15.2±3.8）个月，两组比较差异无统计学意义（t=1.882，P=0.064）.两组手术时间、术中出血量比较差异无统计学意义（P>0.05），但早期手术组的住院时间明显短于延期手术组（P<0.05）.早期手术组与延期手术组的平均骨折愈合时间分别为（5.5±2.8）个月和（6.2±3.1）个月，组间比较差异无统计学意义（t=0.958，P=0.342）；两组末次随访时Lowa踝关节评分分别为87.6±6.8和89.6±5.2，组间比较差异无统计学意义（t=1.351，P=0.182）.早期手术组中术后2例发生腓骨切口周围浅表炎症反应；延期手术组中术后1例胫骨切口周围浅表炎症反应，另有1例术后4个月时发生切口深部迟发性感染，两组术后软组织并发症发生率分别为6.5%和5.7%，两组比较差异无统计学意义（χ2=0.016，P=0.900）. 结论： 对于术前软组织损伤较轻的TscherneⅠ、Ⅱ级胫骨远侧干骺端粉碎性骨折实施损伤早期MIPPO技术治疗并不会显着增加患者的术后软组织并发症发生率，可实现与延期MIPPO技术相当的临床效果。 |
| 【关键词】胫骨骨折 骨折,粉碎性 外科手术,微创性 |
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| Case-control study on minimally invasive percutaneous plate osteosynthesis for the treatment of distal tibial comminuted fractures at different operation times |
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| ABSTRACT Objective: To compare clinical outcomes of minimally invasive percutaneous plate osteosynthesis(MIPPO) in treating distal tibial comminuted fractures at early and delayed stage. Methods: From January 2006 to January 2012,66 patients with distal tibial comminuted fractures were treated by MIPPO. All patients were divided into primary group and delayed group according to operation time. There were 31 patients in primary group,including 18 males and 13 females aged 21 to 57 years old with an average of(39.0±17.8),treated by MIPPO at primary stage,according to Tscherne soft tissue injury,18 cases were gradeⅠ,12 cases were grade Ⅱ and 1 case were grade Ⅲ. Thirty-five patients were treated by MIPPO at delayed stage,including 16 males and 19 females aged 24 to 55 years old with an average of (39.5±15.2),according to Tscherne soft tissue injury,6 cases were gradeⅠ,26 cases were gradeⅡand 3 cases were grade Ⅲ. Operation time,blood loss,hospital stay,fracture healing time and complications of two groups were recorded and observed,Lowa scoring of ankle joint were used to evaluated therapeutic effects at final following and AP and lateral X-rays were used to evaluated fracture reduction and alignment. Results: All patients were followed up,the time of following-up of primary group was(13.5±3.5) months,(15.2±3.8) months in delayed group,there was no significant meaning between two groups(t=1.882,P=0.064 ). There was no significant differences between two groups in operation time and blood loss(P>0.05),but hospital stay in primary group was shorter than that of delayed group(P<0.05). There was no significant meaning between primary group(5.5±2.8) and delayed group(6.2±3.1) in fracture healing time(t=0.958,P=0.342);there was no significant meaning between primary group(87.6±6.8) and delayed group(89.6±5.2) in Lowa scores at final following-up(t=1.351,P=0.182). Two cases occurred postoperative superficial inflammatory reaction around fibular incision in primary group,1 case occurred postoperative superficial inflammatory reaction around fibular incision and 1 case occurred delayed deep incision infection in delayed group at four months after operation. There was no significant differences in incidence of postoperative soft tissue complications between primary group(6.5%) and delayed group(5.7%)(χ2=0.016,P=0.900). Conclusion: For distal tibial comminuted fractures with gradeⅠandⅡof Tscherne soft tissue injury,MIPPO at primary stage can not increase incidence of soft tissue complications,also can obtain the same clinical outcomes just like delayed MIPPO. |
| KEY WORDS Tibial fractures Fractures,comminuted Surgical procedure,minimally invasive |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李强,陈恩良,陈荣良,蒋大权.不同手术时机微创经皮钢板接骨术治疗胫骨远侧干骺端粉碎性骨折的病例对照研究[J].中国骨伤,2014,27(6):508~512 |
| 英文格式: | LI Qiang,CHEN En-liang,CHEN Rong-liang,JIANG Da-quan.Case-control study on minimally invasive percutaneous plate osteosynthesis for the treatment of distal tibial comminuted fractures at different operation times[J].zhongguo gu shang / China J Orthop Trauma ,2014,27(6):508~512 |
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