CAJ | 학술논문

目的：比较损伤早期与延期微创经皮钢板接骨术（minimally invasive percutaneous plate osteosynthesis ， MIPPO）治疗胫骨远侧干骺端粉碎性骨折的临床效果。方法：自2006年1月至2012年1月，采用MIPPO技术治疗闭合性胫骨远侧干骺端粉碎性骨折患者66例。根据手术时机将患者分为两组，早期手术组31例，男18例，女13例；年龄21～57岁，平均（39．0±17．8）岁；在损伤早期即实施MIPPO手术；其中Tscherne软组织损伤Ⅰ级18例，Ⅱ级12例，Ⅲ级例1例。延期手术组35例，男16例，女19例；年龄24～55岁，平均（39．5±15．2）岁；延期接受MIPPO手术；其中Tscherne软组织损伤Ⅰ级6例，Ⅱ级26例，Ⅲ级3例。记录并观察两组患者的手术时间、术中出血量、住院时间、骨折愈合时间及并发症等情况，末次随访时采用Lowa踝关节评分评价患者的功能疗效，采用正侧位X线片评估骨折复位维持及对线情况。结果：两组患者均获随访，早期手术组随访（13．5±3．5）个月，延期手术组随访（15．2±3．8）个月，两组比较差异无统计学意义（t＝1．882，P＝0．064）。两组手术时间、术中出血量比较差异无统计学意义（P＞0．05），但早期手术组的住院时间明显短于延期手术组（P＜0．05）。早期手术组与延期手术组的平均骨折愈合时间分别为（5．5±2．8）个月和（6．2±3．1）个月，组间比较差异无统计学意义（t＝0．958，P＝0．342）；两组末次随访时Lowa踝关节评分分别为87．6±6．8和89．6±5．2，组间比较差异无统计学意义（t＝1．351，P＝0．182）。早期手术组中术后2例发生腓骨切口周围浅表炎症反应；延期手术组中术后1例胫骨切口周围浅表炎症反应，另有1例术后4个月时发生切口深部迟发性感染，两组术后软组织并发症发生率分别为6．5％和5．7％，两组比较差异无统计学意义（χ2＝0．016，P＝0．900）。结论：对于术前软组织损伤较轻的TscherneⅠ、Ⅱ级胫骨远侧干骺端粉碎性骨折实施损伤早期MIPPO技术治疗并不会显著增加患者的术后软组织并发症发生率，可实现与延期MIPPO技术相当的临床效果。目的：比較損傷早期與延期微創經皮鋼闆接骨術（minimally invasive percutaneous plate osteosynthesis ， MIPPO）治療脛骨遠側榦骺耑粉碎性骨摺的臨床效果。方法：自2006年1月至2012年1月，採用MIPPO技術治療閉閤性脛骨遠側榦骺耑粉碎性骨摺患者66例。根據手術時機將患者分為兩組，早期手術組31例，男18例，女13例；年齡21～57歲，平均（39．0±17．8）歲；在損傷早期即實施MIPPO手術；其中Tscherne軟組織損傷Ⅰ級18例，Ⅱ級12例，Ⅲ級例1例。延期手術組35例，男16例，女19例；年齡24～55歲，平均（39．5±15．2）歲；延期接受MIPPO手術；其中Tscherne軟組織損傷Ⅰ級6例，Ⅱ級26例，Ⅲ級3例。記錄併觀察兩組患者的手術時間、術中齣血量、住院時間、骨摺愈閤時間及併髮癥等情況，末次隨訪時採用Lowa踝關節評分評價患者的功能療效，採用正側位X線片評估骨摺複位維持及對線情況。結果：兩組患者均穫隨訪，早期手術組隨訪（13．5±3．5）箇月，延期手術組隨訪（15．2±3．8）箇月，兩組比較差異無統計學意義（t＝1．882，P＝0．064）。兩組手術時間、術中齣血量比較差異無統計學意義（P＞0．05），但早期手術組的住院時間明顯短于延期手術組（P＜0．05）。早期手術組與延期手術組的平均骨摺愈閤時間分彆為（5．5±2．8）箇月和（6．2±3．1）箇月，組間比較差異無統計學意義（t＝0．958，P＝0．342）；兩組末次隨訪時Lowa踝關節評分分彆為87．6±6．8和89．6±5．2，組間比較差異無統計學意義（t＝1．351，P＝0．182）。早期手術組中術後2例髮生腓骨切口週圍淺錶炎癥反應；延期手術組中術後1例脛骨切口週圍淺錶炎癥反應，另有1例術後4箇月時髮生切口深部遲髮性感染，兩組術後軟組織併髮癥髮生率分彆為6．5％和5．7％，兩組比較差異無統計學意義（χ2＝0．016，P＝0．900）。結論：對于術前軟組織損傷較輕的TscherneⅠ、Ⅱ級脛骨遠側榦骺耑粉碎性骨摺實施損傷早期MIPPO技術治療併不會顯著增加患者的術後軟組織併髮癥髮生率，可實現與延期MIPPO技術相噹的臨床效果。
목적：비교손상조기여연기미창경피강판접골술（minimally invasive percutaneous plate osteosynthesis ， MIPPO）치료경골원측간후단분쇄성골절적림상효과。방법：자2006년1월지2012년1월，채용MIPPO기술치료폐합성경골원측간후단분쇄성골절환자66례。근거수술시궤장환자분위량조，조기수술조31례，남18례，녀13례；년령21～57세，평균（39．0±17．8）세；재손상조기즉실시MIPPO수술；기중Tscherne연조직손상Ⅰ급18례，Ⅱ급12례，Ⅲ급례1례。연기수술조35례，남16례，녀19례；년령24～55세，평균（39．5±15．2）세；연기접수MIPPO수술；기중Tscherne연조직손상Ⅰ급6례，Ⅱ급26례，Ⅲ급3례。기록병관찰량조환자적수술시간、술중출혈량、주원시간、골절유합시간급병발증등정황，말차수방시채용Lowa과관절평분평개환자적공능료효，채용정측위X선편평고골절복위유지급대선정황。결과：량조환자균획수방，조기수술조수방（13．5±3．5）개월，연기수술조수방（15．2±3．8）개월，량조비교차이무통계학의의（t＝1．882，P＝0．064）。량조수술시간、술중출혈량비교차이무통계학의의（P＞0．05），단조기수술조적주원시간명현단우연기수술조（P＜0．05）。조기수술조여연기수술조적평균골절유합시간분별위（5．5±2．8）개월화（6．2±3．1）개월，조간비교차이무통계학의의（t＝0．958，P＝0．342）；량조말차수방시Lowa과관절평분분별위87．6±6．8화89．6±5．2，조간비교차이무통계학의의（t＝1．351，P＝0．182）。조기수술조중술후2례발생비골절구주위천표염증반응；연기수술조중술후1례경골절구주위천표염증반응，령유1례술후4개월시발생절구심부지발성감염，량조술후연조직병발증발생솔분별위6．5％화5．7％，량조비교차이무통계학의의（χ2＝0．016，P＝0．900）。결론：대우술전연조직손상교경적TscherneⅠ、Ⅱ급경골원측간후단분쇄성골절실시손상조기MIPPO기술치료병불회현저증가환자적술후연조직병발증발생솔，가실현여연기MIPPO기술상당적림상효과。
Objective:To compare clinical outcomes of minimally invasive percutaneous plate osteosynthesis (MIPPO) in treating distal tibial comminuted fractures at early and delayed stage. Methods:From January 2006 to January 2012,66 pa-tients with distal tibial comminuted fractures were treated by MIPPO. All patients were divided into primary group and delayed group according to operation time. There were 31 patients in primary group ,including 18 males and 13 females aged 21 to 57 years old with an average of(39.0±17.8),treated by MIPPO at primary stage,according to Tscherne soft tissue injury,18 cases were gradeⅠ,12 cases were gradeⅡand 1 case were gradeⅢ. Thirty five patients were treated by MIPPO at delayed stage , including 16 males and 19 females aged 24 to 55 years old with an average of (39.5±15.2),according to Tscherne soft tissue injury,6 cases were gradeⅠ,26 cases were gradeⅡand 3 cases were gradeⅢ. Operation time,blood loss,hospital stay,frac-ture healing time and complications of two groups were recorded and observed ,Lowa scoring of ankle joint were used to evalu-ated therapeutic effects at final following and AP and lateral X rays were used to evaluated fracture reduction and alignment. Results:All patients were followed up,the time of following up of primary group was(13.5±3.5) months,(15.2±3.8) months in delayed group,there was no significant meaning between two groups (t=1.882,P=0.064 ). There was no significant differences between two groups in operation time and blood loss (P>0.05),but hospital stay in primary group was shorter than that of de-layed group(P<0.05). There was no significant meaning between primary group(5.5±2.8) and delayed group(6.2±3.1) in frac-ture healing time(t=0.958,P=0.342);there was no significant meaning between primary group(87.6±6.8) and delayed group (89.6±5.2) in Lowa scores at final following up(t=1.351,P=0.182). Two cases occurred postoperative superficial inflammatory reaction around fibular incision in primary group ,1 case occurred postoperative superficial inflammatory reaction around fibu-lar incision and 1 case occurred delayed deep incision infection in delayed group at four months after operation. There was no significant differences in incidence of postoperative soft tissue complications between primary group (6.5%) and delayed group (5.7%)(χ2=0.016,P=0.900). Conclusion:For distal tibial comminuted fractures with gradeⅠandⅡof Tscherne soft tissue in-jury,MIPPO at primary stage can not increase incidence of soft tissue complications ,also can obtain the same clinical outcomes just like delayed MIPPO.