CAJ | 학술논문

目的：探讨应用解剖型锁定钢板经皮微创与常规开放性手术治疗胫骨远端骨折的临床效果。方法回顾我院2007年1月至2012年12月期间对两组胫骨远端骨折患者实施手术，29例（观察组）应用解剖型锁定钢板经皮微创治疗，27例（对照组）应用常规开放性手术，比较两组患者的手术时间、术中出血量、住院日、踝关节功能保留及Johner-wruhs评分。结果两组患者均获得随访，时间8~24个月，平均随访16个月。所有患者切口均一期愈合，无内固定物松动，无骨不连、骨延迟愈合的发生。观察组：按Johner-wruhs评分，优20例，良6例，可3例，优良率为89.66%。手术时间（85±10）min、术中出血量（110±20）mL、平均住院日（10±2）d，平均临床愈合时间15周，踝关节背伸（20±3）°，踝关节跖屈（38±3）°。对照组：按Johner-wruhs评分，优10例，良10例，可5例，差2例，优良率为74.07%。手术时间（116±10）min、术中出血量（200±30）mL、平均住院日（12±2）d，平均临床愈合时间18周踝关节背伸（10±2）°，踝关节跖屈（26±3）°。两组间各指标进行比较，差异有统计学意义（P<0.05）。结论锁定钢板经皮微创治疗胫骨远端骨折创伤小，骨折愈合率高，伤口并发症少，是一种较理想的手术方法。
목적：탐토응용해부형쇄정강판경피미창여상규개방성수술치료경골원단골절적림상효과。방법회고아원2007년1월지2012년12월기간대량조경골원단골절환자실시수술，29례（관찰조）응용해부형쇄정강판경피미창치료，27례（대조조）응용상규개방성수술，비교량조환자적수술시간、술중출혈량、주원일、과관절공능보류급Johner-wruhs평분。결과량조환자균획득수방，시간8~24개월，평균수방16개월。소유환자절구균일기유합，무내고정물송동，무골불련、골연지유합적발생。관찰조：안Johner-wruhs평분，우20례，량6례，가3례，우량솔위89.66%。수술시간（85±10）min、술중출혈량（110±20）mL、평균주원일（10±2）d，평균림상유합시간15주，과관절배신（20±3）°，과관절척굴（38±3）°。대조조：안Johner-wruhs평분，우10례，량10례，가5례，차2례，우량솔위74.07%。수술시간（116±10）min、술중출혈량（200±30）mL、평균주원일（12±2）d，평균림상유합시간18주과관절배신（10±2）°，과관절척굴（26±3）°。량조간각지표진행비교，차이유통계학의의（P<0.05）。결론쇄정강판경피미창치료경골원단골절창상소，골절유합솔고，상구병발증소，시일충교이상적수술방법。
Objective To discuss the clinical effect of percutaneous minimally invasive and open surgery with anatomic locking plate in the treatment of distal tibial fracture. Methods Retrospective analysis was made on 56 patients operated in our hospital from 2007. 1 to 2012. 12 for distal tibial fracture using by Anatomic locking plate,in which 29 patients were treated by percutaneous minimally invasive surgery( observation group)and 27 patients were treated by open surgery( control group). Comparing difference between two groups on operation time,intraoperative blood loss,hospitalization time,preservation of ankle function and Johner-wruhs score. Results There were no incision infections,no loosening of plate fixation,no bone nonunion or delayed union. All patients were followed-up for 8 to 24 months with an average of 16 months. According to Johner-Wruhs evaluation standard,there were excellent in 20 patients,good in 6 patients and fare in 3 patients in observation group,excellent rate was 89. 66%. In control group there were excellent in 10 patients,good in 10 ptients,fair in 5 patients and poor in 2 pa-tients. The excellent rate was 74. 07%. The operation time,intraoperative blood loss,hospitalization time and preservation of ankle function in observation group were better than control group(P<0. 05). Conclusion Percutaneous minimally invasive surgery using Anatomic locking plate is a effective surgical method for distal tibial fracture,with the advantage of minimal inju-ry,high healing rate and less complications.