实用骨科杂志
實用骨科雜誌
실용골과잡지
JOURNAL OF PRACTICAL ORTHOPEDICS
2014年
8期
715-719
,共5页
任一%胡春宁%陈其宽%蔡瑶%赵久敏%肖松%陆永刚%曹杨彬%刁建%唐广应%胡建山
任一%鬍春寧%陳其寬%蔡瑤%趙久敏%肖鬆%陸永剛%曹楊彬%刁建%唐廣應%鬍建山
임일%호춘저%진기관%채요%조구민%초송%륙영강%조양빈%조건%당엄응%호건산
微创经皮钢板植入术%静态交锁髓内针%胫骨骨折%闭合复位
微創經皮鋼闆植入術%靜態交鎖髓內針%脛骨骨摺%閉閤複位
미창경피강판식입술%정태교쇄수내침%경골골절%폐합복위
minimally invasive percutaneous plate osteosynthesis%intramedullary pin%tibial fractures%close reduction
目的：探讨闭合复位静态交锁髓内针与微创经皮钢板植入术（minimally invasive percutaneous plate osteosyn-thesis，MIPPO）两种微创术式治疗胫骨干中下段不稳定骨折的疗效分析。方法70例胫骨干中下段不稳定新鲜骨折病例，AO 分型42-B1型~42-C3型，随机分为闭合复位静态交锁髓内针固定组40例，MIPPO 组30例，分别住院及门诊随访24个月，观察：a）围手术期项目包括术前等待时间，术中手术时间、出血量，术后肿胀坏死、感染。b）术后2个月、9个月、20个月骨愈合情况。c）术后20个月膝关节 Johner-wruhs 评分、踝关节 Kofoed 评分。评价胫骨干中下段不稳定骨折两种术式的优劣性。结果70例完成住院观察，4例失随访，交锁针失访3例，MIPPO 失访1例，围手术期项目及影像学骨愈合率存在统计学差异，20个月功能评分中，膝关节评分存在统计学差异，踝关节评分无统计学差异。结论闭合复位静态交锁髓内针固定操作简单，医源性损伤小；但延迟愈合发生率高于 MIPPO。骨愈合率及远期膝关节 Johner-wruhs 功能评分及踝关节 Kofoed 功能评分无统计学差异。特殊骨折形态，如大斜面冠状面、螺旋形骨折，以 MIPPO 固定为宜。
目的：探討閉閤複位靜態交鎖髓內針與微創經皮鋼闆植入術（minimally invasive percutaneous plate osteosyn-thesis，MIPPO）兩種微創術式治療脛骨榦中下段不穩定骨摺的療效分析。方法70例脛骨榦中下段不穩定新鮮骨摺病例，AO 分型42-B1型~42-C3型，隨機分為閉閤複位靜態交鎖髓內針固定組40例，MIPPO 組30例，分彆住院及門診隨訪24箇月，觀察：a）圍手術期項目包括術前等待時間，術中手術時間、齣血量，術後腫脹壞死、感染。b）術後2箇月、9箇月、20箇月骨愈閤情況。c）術後20箇月膝關節 Johner-wruhs 評分、踝關節 Kofoed 評分。評價脛骨榦中下段不穩定骨摺兩種術式的優劣性。結果70例完成住院觀察，4例失隨訪，交鎖針失訪3例，MIPPO 失訪1例，圍手術期項目及影像學骨愈閤率存在統計學差異，20箇月功能評分中，膝關節評分存在統計學差異，踝關節評分無統計學差異。結論閉閤複位靜態交鎖髓內針固定操作簡單，醫源性損傷小；但延遲愈閤髮生率高于 MIPPO。骨愈閤率及遠期膝關節 Johner-wruhs 功能評分及踝關節 Kofoed 功能評分無統計學差異。特殊骨摺形態，如大斜麵冠狀麵、螺鏇形骨摺，以 MIPPO 固定為宜。
목적：탐토폐합복위정태교쇄수내침여미창경피강판식입술（minimally invasive percutaneous plate osteosyn-thesis，MIPPO）량충미창술식치료경골간중하단불은정골절적료효분석。방법70례경골간중하단불은정신선골절병례，AO 분형42-B1형~42-C3형，수궤분위폐합복위정태교쇄수내침고정조40례，MIPPO 조30례，분별주원급문진수방24개월，관찰：a）위수술기항목포괄술전등대시간，술중수술시간、출혈량，술후종창배사、감염。b）술후2개월、9개월、20개월골유합정황。c）술후20개월슬관절 Johner-wruhs 평분、과관절 Kofoed 평분。평개경골간중하단불은정골절량충술식적우렬성。결과70례완성주원관찰，4례실수방，교쇄침실방3례，MIPPO 실방1례，위수술기항목급영상학골유합솔존재통계학차이，20개월공능평분중，슬관절평분존재통계학차이，과관절평분무통계학차이。결론폐합복위정태교쇄수내침고정조작간단，의원성손상소；단연지유합발생솔고우 MIPPO。골유합솔급원기슬관절 Johner-wruhs 공능평분급과관절 Kofoed 공능평분무통계학차이。특수골절형태，여대사면관상면、라선형골절，이 MIPPO 고정위의。
Objective To discuss clinical effect of two kinds of minimally invasive surgery(the closed reduction and the static interlocking intramedullary nailing and MIPO)in the treatment of unstable fractures of distal tibia. Methods According to the AO criteria,70 42-B1 ~ 42-C3 tibial distal unstable fresh fractures cases were divided into two groups randomly. There were 40 cases in the closed reduction and static interlocking intramedullary nail fixation group,and the other 30 cases in the MIPO group. Then we observed all the cases difference during inpatient and outpatient follow - up for 24 months. Time before operation,operation time,intraoperative bleeding,postoperative swelling,necrosis and infection were recorded. The fracture healing after 2 months,9 months and 20 months of the surgery were accessed. And the function of the knee and ankle joint was assessed according to Johner - wruhs' knee function score and Kofoed's ankle function score after 20 months of the surgery. Results 70 cases complete hospital observation. 4 cases were lost to follow - up,including 3 Interlocking needle cases and 1 MIPPO case. Perioperation period of the project and radiographic bone healing rate exist statistical difference. The knee func-tion score showed statistical difference,while the ankle function score showed no difference. Conclusion During the Perioper-ation period,the closed reduction and static interlocking intramedullary nail fixation is simple and has less injury,what's more, its rate of delay union is lower than MIPPO. There's no statistical difference through bone healing rate,Johner - wruhs' knee function score and Kofoed's ankle function score. MIPPO fixation is better in the treatment of special fracture morphology,such as oblique coronal and spiral fracture.
