胫骨骨折闭合复位经皮置入锁定钢板固定与切开复位钢板内固定疗效比较_胫骨骨折切开复位钢板内固定术

　　[摘要] 目的 探讨两种不同手术方式治疗胫骨骨折的疗效对比情况，以便更好地开展胫骨骨折的手术治疗。 方法 将我院2008年1月～2011年1月收治的76例胫骨远端骨折患者分成两组，分别采用闭合复位微创经皮置入锁定钢板固定术（minimal invasive percutaneous plate osteosynthesis，MIPPO）及传统切开复位内固定术（open reduction and internal fixation，ORIF）。通过对两组手术时间、住院时间、骨折愈合时间、并发症的发生率及优良率进行比较，并作统计学分析。 结果 两组优良率及并发症发生率比较差异均无统计学意义（P ＞ 0.05）。两组骨折愈合时间比较差异无统计学意义（P ＞ 0.05），MIPPO组的手术时间及住院时间比较显著短于ORIF组（P ＜ 0.01）。 结论 根据骨折类型及软组织的条件等，选择适当的手术时机及遵循手术个体化原则，在条件允许的情况下，应尽量采用MIPPO技术治疗胫骨远端骨折。
　　[关键词] 胫骨骨折；经皮置入锁定钢板固定；切开复位；疗效比较
　　[中图分类号] R683.42 [文献标识码] A [文章编号] 1673-7210（2012）07（c）-0033-02
　　Treatment efficacy comparison of minimal invasive percutaneous plate osteosynthesis and open reduction and internal fixation in the treatment of tibial fracture
　　QIU Jiren LU Maode GE Shunjie ZHANG Taifeng LUO Kunlie
　　Department of Orthopedics, the Second People"s Hospital of Qinzhou City, Guangxi Zhuang Autonomous Region, Qinzhou 535000, China
　　[Abstract] Objective To investigate the efficacy comparison of two different surgical treatment of tibial fracture in order to improve the surgical treatment of tibial fractures. Methods 76 distal tibial fracture patients admitted to the authors" hospital from January 2008 to January 2011 were assigned to two groups and were treated with minimal invasive percutaneous plate osteosynthesis (MIPPO) and the traditional open reduction and internal fixation (ORIF). Operative time, hospital stay, fracture healing time, incidence of complications and excellent rate of the two group were compared and subjected to statistical analysis. Results Excellent rates, incidence of complications and fracture healing time were not significantly different between the two groups (P ＞ 0.05). Operation time and hospital stay of MIPPO group were significantly shorter than those of the ORIF group (P ＜ 0.01). Conclusion Appropriate timing of surgery should be selected based on the type of fracture and soft tissue conditions and principle of individualized surgery should be followed. If condition permits, MIPPO should be chosen in the treatment of distal tibial fractures.
　　[Key words] Tibial fractures; Minimal invasive percutaneous plate osteosynthesis; Open reduction; Efficacy comparison
　　胫骨骨折在临床是比较常见的骨折，发生率约占全身骨折的10%[1]，而远端发生骨折的几率最高[2]。由于胫骨远端特有软组织少、血供少、术后愈合时间长等特点，传统切开复位内固定术（open reduction and internal fixation，ORIF）手术存在骨折延迟愈合、不愈合、骨筋膜室综合征等严重并发症。随着生物学技术及闭合复位微创经皮置入锁定钢板固定术（minimal invasive percutaneous plate osteosynthesis，MIPPO）手术的临床推广及应用，MIPPO体现了其优越性，本文通过回顾性分析两组手术方式患者的临床资料，比较MIPPO及ORIF在临床中的应用价值，现报道如下：