Cai Peng-Fei, Zhao Wei, Wang Jin-Hua, Chen Ren-Sheng, Li Xiao-Fei
Department of Trauma Orthopaedics, Jinhua Central Hospital, Jinhua 321000, Zhejiang, China.
Zhongguo Gu Shang. 2025 Mar 25;38(3):273-9. doi: 10.12200/j.issn.1003-0034.20230810.
To compare clinical effects of external fixation and minimally invasive percutaneous plate osteosynthesis (MIPPO) after external fixation in treating open fractures of tibial shaft.
From January 2020 to June 2022, 151 patients with open fracture of tibial shaft treated with external fixation stenting were divided into external fixation group and combined group according to different surgical methods. There were 81 patients in external fixation group, including 48 males and 33 females, aged from 21 to 68 years old with an average of (42.58±7.44) years old;according to Gustilo classification, 49 patients with typeⅡ, 32 patients with type ⅢA;the time from injury to treatment ranged from 2.5 to 10 h with an average of (4.25±0.74) h;external fixed stenting was performed. There were 70 patients in combined group, including 42 males and 28 females, aged from 20 to 69 years old with an average of (41.39±7.02) years old;35 patients with type Ⅱ and 35 patients with type ⅢA according to Gustilo classification;the time from injury to treatment ranged from 3 to 9 h with an average of (4.31±0.85) h;MIPPO treatment was performed after external fixed stenting. The time of callus formation, fracture healing and complications were compared between two groups. Rasmussen score and Hospital for Special Surgery (HSS) score were used to evaluate functional recovery of knee joint at 6 months after operation.
Both groups were followed up for 6 to 13 months with an average of (10.17±2.33) months. The time of callus formation and fracture healing were (13.98±4.02) d and (70.26±12.15) d in combined group, and (18.56±4.37) d and (79.87±15.41) d in external fixation group, respectively. Combined group was better than external fixation group in the time of callus formation and fracture healing (<0.05). At six months after operation, Rasmussen and HSS scores in combined group were (26.79±3.11) and (83.36±9.44), which were higher than those in external fixation group (24.51±4.63) and (79.63±8.46) (<0.05). In external fixation group, there were 2 patients with incision infection, 2 patients with nail tract infection, 1 patient with stent loosening, fracture displacement, delayed union and malunion, and 1 patient with biocompatibility reaction in combined group, with statistical significance between two groups (<0.05).
MIPPO could accelerate callus formation and fracture healing, improve knee function, improve clinical effects and reduce complications in patients with open tibial shaft fractures after external and external fixation.
比较外固定与外固定后微创经皮钢板接骨术（MIPPO）治疗胫骨干开放性骨折的临床效果。
选取2020年1月至2022年6月采用外固定支架治疗的151例胫骨干开放性骨折患者，根据手术方式不同分为外固定组和联合组。外固定组81例，男48例，女33例，年龄21～68岁，平均（42.58±7.44）岁；按Gustilo分类，Ⅱ型49例，ⅢA型32例；受伤至治疗时间2.5～10 h，平均（4.25±0.74）h；行外固定支架固定。联合组70例，男42例，女28例，年龄20～69岁，平均（41.39±7.02）岁；按Gustilo分类，Ⅱ型35例，ⅢA型35例；受伤至治疗时间3～9 h，平均（4.31±0.85）h；外固定支架固定后行MIPPO治疗。比较两组骨痂形成时间、骨折愈合时间及并发症发生情况。采用Rasmussen评分和美国特种外科医院（HSS）评分评估术后6个月膝关节功能恢复情况。
两组均随访6～13个月，平均（10.17±2.33）个月。联合组骨痂形成时间和骨折愈合时间分别为（13.98±4.02）d和（70.26±12.15）d，外固定组分别为（18.56±4.37）d和（79.87±15.41）d。联合组骨痂形成时间和骨折愈合时间均优于外固定组（<0.05）。术后6个月，联合组Rasmussen评分和HSS评分分别为（26.79±3.11）和（83.36±9.44），高于外固定组的（24.51±4.63）和（79.63±8.46）（<0.05）。外固定组发生切口感染2例、钉道感染2例、支架松动1例、骨折移位、延迟愈合及畸形愈合各1例，联合组发生生物相容性反应1例，两组比较差异有统计学意义（<0.05）。
MIPPO可加速胫骨干开放性骨折患者外固定后骨痂形成和骨折愈合，改善膝关节功能，提高临床疗效，减少并发症。
