陈建

[摘要] 目的 比较微创经皮钢板接骨技术（MIPPO）+锁定加压接骨板（LCP）与闭合复位静态交锁髓内钉在胫骨远端骨折中的应用效果。 方法 选取2017年6月至2019年5月本院收治的胫骨远端骨折患者78例，按照随机数字表法分为对照组和观察组，每组各39例。对照组予闭合复位静态交锁髓内钉治疗，观察组予MIPPO+LCP治疗，比较两组一般手术指标、骨折愈合时间、术后并发症发生情况及手术前后膝关节和踝关节功能。 结果 观察组手术时间、透视时间均长于对照组，但术中出血量少于对照组，差异有统计学意义（P<0.05）;两组切口长度、住院时间、骨折愈合时间比较，差异无统计学意义（P>0.05）;术后6个月，兩组膝关节和踝关节功能评分均高于术前，观察组高于对照组，差异有统计学意义（P<0.05）;术后随访1年，观察组术后并发症总发生率低于对照组，差异有统计学意义（P<0.05）。 结论 与闭合复位静态交锁髓内钉相比，MIPPO+LCP治疗胫骨远端骨折具有出血量少、并发症发生率低、术后膝关节和踝关节功能恢复好的优势，值得临床推广。

[关键词] 微创经皮钢板接骨技术;锁定加压接骨板;闭合复位;交锁髓内钉;胫骨远端骨折;应用效果

[中图分类号] R683.42          [文献标识码] B          [文章编号] 1673-9701（2021）08-0072-04

Comparison of the effect of minimally invasive percutaneous plate osteosynthesis+LCP versus closed reduction and static interlocking intramedullary nail in the treatment of distal tibial fractures

CHEN Jian

Department of Orthopedics， the Third Affiliated Hospital of Gannan Medical College， Ganzhou   341000， China

[Abstract] Objective To compare the effect of minimally invasive percutaneous plate osteosynthesis （MIPPO） + locking compression plate（LCP） versus closed reduction and static interlocking intramedullary nail in distal tibial fractures. Methods A total of 78 patients with distal tibial fractures admitted to our hospital from June 2017 to May 2019 were selected and divided into the observation group （n=39） and the control group （n=39） according to the random number table method. The control group was treated with closed reduction and static interlocking intramedullary nail， while the observation group was treated with MIPPO+LCP. The general surgical indexes， fracture healing time， postoperative complications and knee and ankle functions were compared between the two groups. Results The operative time and fluoroscopy time of the observation group were statistically significant longer than those of the control group， but the intraoperative blood loss was statistically significant less than that of the control group（P<0.05）. There were no statistically significant differences in incision length， hospitalization time or fracture healing time between the two groups（P>0.05）. After 6 months of treatment， the scores of knee and ankle functions in both groups were statistically significant higher than those before surgery， and those in the observation group were statistically significant higher than those in the control group（P<0.05）. During one-year follow-up after surgery， the total incidence of postoperative complications in the observation group was statistically significant lower than that in the control group（P<0.05）. Conclusion Compared with closed reduction and static interlocking intramedullary nail， MIPPO+LCP in the treatment of distal tibial fractures has the advantages of less blood loss， lower incidence of complications and better recovery of knee and ankle functions after operation， which is worthy of clinical promotion.

[Key words] Minimally invasive percutaneous plate osteosynthesis; Locking compression plate; Closed reduction; Interlocking intramedullary nail; Distal tibial fractures; Application effect

胫骨骨折发生率约占全身骨折的13.7%[1]，其中10%～13%为胫骨远端骨折[2]。由于胫骨远端靠近踝关节，远端骨折部位固定范圍小而不稳定，且其软组织覆盖薄、血供较差，易出现伤口感染、骨折延迟愈合等并发症[3-4]，故临床治疗胫骨远端骨折时，需重视手术方式的选择[5]。既往临床治疗胫骨远端骨折以切开复位内固定术为主，但该手术切口大，容易二次损伤骨折部位血供，继而增加并发症的发生率[6]。本研究将微创经皮钢板接骨技术（Minimally invasive percutaneous plate osteosynthesis，MIPPO）+锁定加压接骨板（Locking compression plate，LCP）及闭合复位静态交锁髓内钉分别应用于两组胫骨远端骨折患者的治疗中，比较两种治疗方法应用效果的差异，现报道如下。……