中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (17): 3116-3120.doi: 10.3969/j.issn.1673-8225.2012.17.018

• 骨髓干细胞 bone marrow stem cells • 上一篇    下一篇

经皮微创钢板固定治疗胫骨下段骨折：与髓内钉固定和切开复位钢板内固定的比较★

梁博伟1，赵劲民1，殷国前2，胡  峰1，盘荣贵1   

  1. 广西医科大学第一附属医院，1创伤骨科手外科，  2整形外科，广西壮族自治区南宁市  530021
  • 收稿日期:2011-09-14 修回日期:2011-12-15 出版日期:2012-04-22 发布日期:2012-04-22
  • 通讯作者: 赵劲民，博士生导师，教授，广西医科大学第一附属医院创伤骨科手外科，广西壮族自治区南宁市 530021 zhaojinmin@126.com
  • 作者简介:梁博伟★，男，1973年生，广西壮族自治区博白县人，汉族，2005年中山大学毕业，硕士，主治医师，主要从事创伤、脊柱外科研究。LBW5515@163.com

Minimally invasive percutaneous plate osteosynthesis for distal tibial fractures: Compared with intramedullary nail fixation and open reduction and plate fixation

Liang Bo-wei1, Zhao Jin-min1, Yin Guo-qian2, Hu Feng1, Pan Rong-gui1   

  1. 1Department of Traumatic Orthopedics and Hand Surgery, 2Department of Plastic and Cosmetic Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning  530021, Guangxi Zhuang Autonomous Region, China
  • Received:2011-09-14 Revised:2011-12-15 Online:2012-04-22 Published:2012-04-22
  • Contact: Zhao Jin-min, Doctoral supervisor, Professor, Department of Traumatic Orthopedics and Hand Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China zhaojinmin@126.com
  • About author:Liang Bo-wei★, Master, Attending physician, Department of Traumatic Orthopedics and Hand Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China LBW5515@163.com

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摘要：

背景：经皮微创钢板固定、髓内钉固定及切开复位钢板内固定是治疗胫骨下段骨折的有效方法，3者各有优缺点。
目的：比较经皮微创钢板固定与髓内钉固定、切开复位钢板内固定治疗胫骨下段骨折的疗效差异。
方法：2007-03/2010-05收治胫骨下段骨折患者85例，采用经皮微创钢板固定治疗25例，髓内钉固定31例，切开复位钢板内固定29例。记录3组的手术创伤、全身炎性反应、胫骨功能恢复、软组织损伤及骨折愈合的指标。
结果与结论：3种固定方式均能有效治疗胫骨下段闭合性骨折；经皮微创钢板固定和髓内钉固定在手术创伤、软组织损伤及胫骨功能恢复方面比较差异无显著性意义，但均优于切开复位钢板内固定；在骨折愈合方面，与切开复位钢板内固定相比，经皮微创钢板固定和髓内钉固定在治疗A型骨折方面无优势，但在治疗B、C型骨折方面优势明显；经皮微创钢板固定具有手术创伤和软组织损伤小、全身炎性反应轻、胫骨功能恢复良好、骨折愈合快的优点，但面临着固定过程中骨折复位困难和固定后畸形愈合增加的风险。

关键词: 经皮微创钢板固定, 髓内钉固定, 切开复位钢板内固定, 胫骨下段骨折, 疗效

Abstract:

BACKGROUND: Minimally invasive percutaneous plate osteosynthesis (MIPPO), intramedullary nail fixation (INF) and open reduction and plate fixation (ORPF) are the effective treatments for distal tibial fracture with different advantages and disadvantages, respectively. OBJECTIVE: To compare the different clinical outcomes of MIPPO with INF and ORPF for treatment of distal tibial fractures.
METHODS: From March 2007 to May 2010, 85 cases of distal tibial fracture treated with MIPPO (n=25), INF (n=31) and ORPF (n=29) were selected. The indexes of surgical trauma, systemic inflammatory response, functional recovery of tibia, soft tissue injury and union of fractures were compared among the three groups.
RESULTS AND CONCLUSION: The MIPPO, INF and ORPF were all effective treatments for distal tibial fractures. There were no significant differences of the indexes in surgical trauma, soft tissue injury and functional recovery of tibia between the MIPPO and INF groups, but both were better than those of the ORPF group. In terms of fracture healing, there were no differences among the 3 groups in the treatment of type A distal tibial fracture, but obvious advantages were found in the treatment of type B and C fractures in the MIPPO and INF groups as compared with the ORPF group. MIPPO are found to have minimal surgical trauma and soft tissue injury, slighter postoperative systemic inflammatory response, better functional recovery of tibia and faster fracture healing but facing challenge of reduction intraoperatively and increasing risk of malunion postoperatively.

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