付玉帅

摘   要：目的  對比交锁髓内钉与微创经皮钢板内固定治疗胫骨中下段骨折的临床疗效及其生物力学性能。方法  选择2016年2月～2017年1月来我院治疗的胫骨中下段骨折患者152例，根据治疗方式分为两组。IMN组76例采用交锁髓内钉治疗，MIPPO组76例采用微创经皮钢板内固定治疗，观察两组患者术后1年踝关节Mazur评分优良率。另选择成人踝关节标本20具，随机分为两组，实验组10例采用IMN固定，对照组10例采用MIPPO固定，实现固定后取正、侧位拍X线片，开展三点弯曲、轴向压缩试验以及扭转强度试验，并比对两组数据。结果  IMN组和MIPPO组术后1年Mazur评分优良率相近，差异无统计学意义（P>0.05）。实验组弯曲偏移量、轴向压缩偏移量以及扭转角度均大于对照组，差异具有统计学意义（P<0.05）。结论  MIPPO与IMN两种术式治愈胫骨中下段骨折方面无明显优劣，MIPPO可减少手术创伤，但力学性能相对较差，临床应用时需明确各自手术适应症，合理运用。

关键词：交锁髓内钉;微创经皮钢板内固定;生物力学性能;胫骨中下段骨折

中图分类号：R687.3                                   文献标识码：A                               DOI：10.3969/j.issn.1006-1959.2018.16.024

文章编号：1006-1959（2018）16-0085-03

Effect of IMN and MIPPO on Fracture of Middle and Distal Tibia and Biomechanical  Properties Analysis

FU Yu-shuai

（Department of Orthopaedics，Central People's Hospital of Xiuyan Manchu Autonomous County，Anshan 114300，Liaoning，China）

Abstract：Objective  To compare the clinical efficacy and biomechanical properties of interlocking intramedullary nail and minimally invasive percutaneous plate fixation in the treatment of middle and distal tibial fractures.Methods  From February 2016 to January 2017，152 patients with middle and lower tibial fractures were divided into two groups.76 cases in IMN group were treated with interlocking intramedullary nail and 76 cases in MIPPO group were treated with minimally invasive percutaneous plate fixation.The excellent and good rate of Mazur score of ankle joint was observed one year after operation.Another 20 adult ankle specimens were randomly divided into two groups.10 cases in the experimental group were fixed with IMN and 10 cases in the control group were fixed with MIPPO.After fixation，the X-ray films were taken in both the forward and the lateral positions.Three-point bending test， axial compression test and torsional strength test were carried out，and the data of the two groups were compared.Results  The excellent and good rate of Mazur score was similar between IMN group and MIPPO group one year after operation，the difference was not statistically significant（P>0.05）.The bending offset，axial compression offset and torsion angle of the experimental group were greater than those of the control group，the difference was statistically significant（P<0.05）.Conclusion  MIPPO and IMN have no obvious advantages and disadvantages in the treatment of middle and lower tibiofibular fractures.MIPPO can reduce surgical trauma， but the mechanical properties are relatively poor.The clinical indications should be clear and appropriate.

Key words：Interlocking intramedullary nail;Minimally invasive percutaneous plate fixation;Biomechanical properties;Middle and distal tibial fractures

患者胫骨中下段骨折多由于高处摔落、交通事故或是摔倒等多种外力因素造成，占人体骨折发生率的8%～15%[1]。交锁髓内钉与微创经皮钢板固定是目前胫骨中下段骨折临床应用的主要术式。交锁髓内钉（IMN）为中心固定，较为稳定，多用以治疗长斜形或是横行骨折[2]。微创经皮钢板内固定（MIPPO）则属于微创手术，是新型固定方法，与生物学固定原则相符，可降低手术对患者胫骨软组织与胫骨供血系统的负面影响。本文探究两种手术在治疗胫骨中下段骨折方面的治疗效果及生物力学性能，报道如下。

1资料与方法

1.1一般资料  选择2016年2月～2017年1月来鞍山市岫岩满族自治县中心人民医院治疗的胫骨中下段骨折患者152例，根据术式不同分为IMN组与MIPPO组，每组76例。I……