[两种手术治疗胫骨远端关节外骨折的对比研究]

[Comparison study on two operations for treatment of extra-articular distal tibial fracture].

作者信息

Qi Haotian, Li Weikang, Zhao Yongjie, Zhang Yinguang, Liu Zhaojie, Jia Jian

机构信息

The Graduate College of Tianjin Medical University, Tianjin, 300200, P.R.China.

Area III of Traumatic Orthopedic Department, Tianjin Hospital.

出版信息

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Nov;27(11):1286-90.

PMID:24501883

Abstract

OBJECTIVE

To compare the effectiveness between minimally invasive plate osteosynthesis (MIPO) and open reduction and internal fixation (ORIF) for treatment of extra-articular distal tibial fracture.

METHODS

Between March 2009 and March 2012, 57 patients with extra-articular distal tibial fractures were treated, and the clinical data were retrospectively analyzed. Of 57 cases, 31 were treated with MIPO (MIPO group), and 26 with ORIF (ORIF group). There was no significant difference in gender, age, cause of injury, type of fractures, complication, and time from injury to operation between 2 groups (P > 0.05). The operation time, intraoperative blood loss, fracture healing time, and complications were compared between 2 groups.

RESULTS

There was no significant difference in operation time and intraoperative blood loss between 2 groups (P > 0.05). Wound infection occurred in 5 cases [2 in MIPO group (6.5%) and 3 in ORIF group (11.5%)] showing no significant difference (Chi(2)=0.651, P=0.499). The other wound obtained healing by first intention. All cases were followed up 13-24 months (mean, 15 months). No significant difference was found in the average healing time between 2 groups and between patients with types A and B by AO classification (P > 0.05); in patients with type C, the healing time in MIPO group was significantly shorter than that in ORIF group (t= -2.277, P=0.033). Delayed union was observed in 3 cases of MIPO group (9.7%) and in 4 cases of ORIF group (15.4%), showing no significant difference (Chi(2)=0.428, P=0.691). Mal-union occurred in 4 cases of MIPO group (12.9%) and in 1 case of ORIF group (3.8%), showing no significant difference (Chi(2)=1.449, P=0.362). No significant difference was found in Mazur score between 2 groups (t=0.480, P=0.633). The excellent and good rate was 93.5% in MIPO group (excellent in 24 cases, good in 5 cases, fair in 1 case, and poor in 1 case) and was 92.3% in ORIF group (excellent in 18 cases, good in 6 cases, and poor in 2 cases), and the difference was not significant (Z= -0.687, P=0.492).

CONCLUSION

Both MIPO and ORIF have good results in treating extra-articular distal tibial fractures. MIPO is superior to ORIF for treating complex and communited fractures.

摘要

目的

比较微创钢板接骨术（MIPO）与切开复位内固定术（ORIF）治疗胫骨远端关节外骨折的疗效。

方法

回顾性分析2009年3月至2012年3月间57例胫骨远端关节外骨折患者的临床资料。57例患者中，31例行MIPO治疗（MIPO组），26例行ORIF治疗（ORIF组）。两组患者在性别、年龄、受伤原因、骨折类型、并发症及受伤至手术时间等方面差异无统计学意义（P>0.05）。比较两组患者的手术时间、术中出血量、骨折愈合时间及并发症情况。

结果

两组患者手术时间和术中出血量差异无统计学意义（P>0.05）。5例发生伤口感染[MIPO组2例（6.5%），ORIF组3例（11.5%）]，差异无统计学意义（χ²=0.651，P=0.499）。其余伤口均一期愈合。所有患者均获随访，随访时间13 - 24个月（平均15个月）。两组患者平均愈合时间及AO分型中A、B型患者间差异无统计学意义（P>0.05）；C型患者中，MIPO组愈合时间明显短于ORIF组（t=-2.277，P=0.033）。MIPO组3例（9.7%）发生延迟愈合，ORIF组4例（15.4%）发生延迟愈合，差异无统计学意义（χ²=0.428，P=0.691）。MIPO组4例（12.9%）发生畸形愈合，ORIF组1例（3.8%）发生畸形愈合，差异无统计学意义（χ²=1.449，P=0.362）。两组Mazur评分差异无统计学意义（t=0.480，P=0.633）。MIPO组优良率为93.5%（优24例，良5例，可1例，差1例），ORIF组优良率为92.3%（优18例，良6例，差2例），差异无统计学意义（Z=-0.687，P=0.492）。