摘要
目的比较外固定支架、专家级髓内钉（ETN）、经皮微创接骨板（MIPPO）固定方法治疗AO分型43-A型胫骨骨折的临床疗效及适应证。方法回顾性分析2010年6月至2014年6月收治的102例AO分型43-A型胫骨骨折患者的临床资料，男68例，女34例；年龄18～71岁，平均36岁。骨折AO分型：A1型36例，A2型45例，A3型21例。根据治疗方式不同分为3组：外固定组（30例），MIPPO组（42例），ETN组（30例），记录并比较各组手术时间、术中出血量以及末次随访时美国足踝外科协会（AOFAS）中前足评分等。结果手术时间外固定组为（72．7±16．1）min，明显小于MIPPO组【（101．5±15．1）min]及ETN组【（115．0±11．2）min]；术中出血量及骨折临床愈合时间外固定组分别为（320．6±40．8）mL、（160．6±25．0）d，均大于MIPPO组[（125．5±27．3）mL、（120．3±20．2）d】和ETN组【（124．2±25．4）mL、（125．5±25．6）d]；并发症发生率外固定组（53．3％，16／30）明显高于MIPPO组（9．5％，4／42）及ETN组（10．0％，3／30）；AOFAS中前足评分功能优良率外固定组（66．7％，20／30）明显低于MIPPO组（88．1％，37／42）及ETN组（90．0％，27／30）；以上项目比较差异均有统计学意义（P〈0．05），但上述指标MIPPO组与ETN组相比差异均无统计学意义（P〉0．05）。结论对于AO分型43．A型胫骨骨折，应首选内固定治疗，MIPPO技术和ETN均能取得良好的临床疗效；而不适合内固定者，远端交叉置钉不跨踝关节外固定亦可获得满意的关节功能。
Objective To compare the clinical effectiveness of external fixation, expert tibial nail （ETN） and minimally invasive percutaneous plate osteosynthesis （MIPPO） in the treatment of AO type 43A tibial fractures. Methods The clinical data of 102 patients with AO type 43A tibial fracture were ret- rospectively analyzed who had been treated from June 2010 to June 2014. They were 68 men and 34 women, from 18 to 71 years of age （average, 36 years） . By AO classification, there were 36 cases of type A1, 45 ones of type A2, and 21 ones of type A3. External fixation was used in 30 cases, MIPPO in 42, and ETN in 30. The 3 groups were compared in terms of operation time, blood loss, fracture healing time, complications and functional evaluation according to American Orthopaedic Foot and Ankle Society （AOFAS） criteria for middle and fore foot. Results The operation time in external fixation group （72. 7 ± 16. 1 min） was significantly less than in MIPPO group （101.5 ± 15.1 min） and ETN group （ 115.0 ± 11.2 min） （ P 〈 0.05） . The blood loss and fracture healing time in external fixation group were （320. 6 ±40.8 mL） and （160. 6 ±25.0 days）, significantly greater than in MIPPO group （125.5 ±27.3 mL and 120. 3 ±20. 2 days）and ETN group （124.2± 25.4 mL and 125.5 ±25.6 days） （ P 〈 0.05） . The total complication rate in external fixation group （53.3%, 16/30） was significantly higher than in MIPPO group （9.5%, 4/42） and ETN group （10. 0%, 3/30） （P 〈 0. 05）. The total AOFAS excellent to good rate in external fixation group （66.7%, 20/30） was significantly lower than in MIPPO group （88.1%, 37/42） and ETN group （90. 0%, 27/30） （ P 〈 0.05）. However, there were no significant differences between MIPPO and ETN groups con- cerning all the above outcome indicators （ P 〉 0.05 ）. Conclusions For AO type 43A tibial fractures, internal fixation should be the first choice. Both MIPPO and ETN can lead to good clinical efficacy. However, in cas
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2016年第7期579-585,共7页
Chinese Journal of Orthopaedic Trauma
关键词
胫骨骨折
骨折固定术
内
外固定器
软组织损伤
Tibial fractures
Fracture fixation, interal
External fixators
Soft tissue injury
