Fang Jun-Hao, Wu Yao-Sen, Guo Xiao-Shan, Sun Liao-Jun
Orthopedics. 2016 Jul 1;39(4):e627-33. doi: 10.3928/01477447-20160606-01. Epub 2016 Jun 13.
This study compared the results of external fixation combined with limited open reduction and internal fixation (EF + LORIF), minimally invasive percutaneous plate osteosynthesis (MIPPO), and intramedullary nailing (IMN) for distal tibia fractures. A total of 84 patients with distal tibia shaft fractures were randomized to operative stabilization using EF + LORIF (28 cases), MIPPO (28 cases), or IMN (28 cases). The 3 groups were comparable with respect to patient demographics. Data were collected on operative time and radiation time, union time, complications, time of recovery to work, secondary operations, and measured joint function using the American Orthopaedic Foot and Ankle Society (AOFAS) score. There was no significant difference in time to union, incidence of union status, time of recovery to work, and AOFAS scores among the 3 groups (P>.05). Mean operative time and radiation time in the MIPPO group were longer than those in the IMN or EF + LORIF groups (P<.05). Wound complications after MIPPO were more common compared with IMN or EF + LORIF (P<.05). Anterior knee pain occurred frequently after IMN (32.1%), and irritation symptoms were encountered more frequently after MIPPO (46.4%). Although EF + LORIF was associated with fewer secondary procedures vs MIPPO or IMN, it was related with more pin-tract infections (14.3%). Findings indicated that EF + LORIF, MIPPO, and IMN all achieved similar good functional results. However, EF + LORIF had some advantages over MIPPO and IMN in reducing operative and radiation times, postoperative complications, and reoperation rate. [Orthopedics. 2016; 39(4):e627-e633.].
本研究比较了外固定结合有限切开复位内固定（EF + LORIF）、微创经皮钢板接骨术（MIPPO）和髓内钉固定术（IMN）治疗胫骨干远端骨折的效果。共有84例胫骨干远端骨折患者被随机分为采用EF + LORIF（28例）、MIPPO（28例）或IMN（28例）进行手术固定。三组患者在人口统计学特征方面具有可比性。收集了手术时间、透视时间、骨折愈合时间、并发症、恢复工作时间、二次手术情况的数据，并使用美国矫形足踝协会（AOFAS）评分来衡量关节功能。三组在骨折愈合时间、愈合状态发生率、恢复工作时间和AOFAS评分方面无显著差异（P>0.05）。MIPPO组的平均手术时间和透视时间长于IMN组或EF + LORIF组（P<0.05）。与IMN或EF + LORIF相比，MIPPO术后伤口并发症更常见（P<0.05）。IMN术后经常出现前膝疼痛（32.1%），MIPPO术后刺激症状更常见（46.4%）。虽然与MIPPO或IMN相比，EF + LORIF的二次手术较少，但与更多的针道感染相关（14.3%）。研究结果表明，EF + LORIF、MIPPO和IMN均取得了相似的良好功能结果。然而，EF + LORIF在缩短手术和透视时间、术后并发症及再次手术率方面比MIPPO和IMN具有一些优势。[《骨科学》。2016年；39(4):e627 - e633。]
