CAJ | 학술논문

目的对比微创接骨板(MIPO)技术和皮外钢板固定技术治疗胫骨远端骨折的临床效果.方法 2010年1月至2012年1月,宁波市第六医院骨科采用MIPO技术和皮外钢板固定技术治疗闭合性胫骨远端骨折患者48例.MIPO组24例,男16例,女8例.平均年龄36(20 ～57)岁.骨折类型A型15例,B型6例,C型3例.皮外钢板固定组24例,男16例,女8例.平均年龄37(23 ～59)岁.骨折类型A型15例,B型6例,C型3例.比较两组的手术时间、住院时间、骨折愈合时间、并发症及踝关节功能.结果患者术后平均随访18.5(12 ～26)个月.两组均未出现骨折不愈合、内固定失败、深部感染等并发症.皮外钢板固定组在手术时间、住院时间以及骨折愈合时间均短于MIPO组,差异有统计学意义.MIPO组有3例伤口浅部感染及1例延迟愈合,而皮外钢板固定组无上述并发症,但两组之间差异无统计学意义.MIPO组15例(62.5％)患者因内置物激惹要求拆除内固定,15.6％的螺钉在拆除过程中发生滑丝,而皮外钢板固定组患者无内置物激惹并发症,并且所有患者均在门诊无麻醉下顺利取出内固定.踝关节功能评定按照AOFAS评分MIPO组和皮外钢板固定组分别为(90.7±3.8)分和(88.9±4.1)分,两者之间差异无统计学意义.结论 MIPO技术和皮外钢板固定技术在胫骨远端骨折的治疗中都可以取得较满意的疗效.但皮外钢板固定技术在手术时间、住院时间、骨折愈合时间、内置物激惹及内固定取出方面具有明显优势.
목적 대비미창접골판(MIPO)기술화피외강판고정기술치료경골원단골절적림상효과.방법 2010년1월지2012년1월,저파시제륙의원골과채용MIPO기술화피외강판고정기술치료폐합성경골원단골절환자48례.MIPO조24례,남16례,녀8례.평균년령36(20 ～57)세.골절류형A형15례,B형6례,C형3례.피외강판고정조24례,남16례,녀8례.평균년령37(23 ～59)세.골절류형A형15례,B형6례,C형3례.비교량조적수술시간、주원시간、골절유합시간、병발증급과관절공능.결과 환자술후평균수방18.5(12 ～26)개월.량조균미출현골절불유합、내고정실패、심부감염등병발증.피외강판고정조재수술시간、주원시간이급골절유합시간균단우MIPO조,차이유통계학의의.MIPO조유3례상구천부감염급1례연지유합,이피외강판고정조무상술병발증,단량조지간차이무통계학의의.MIPO조15례(62.5％)환자인내치물격야요구탁제내고정,15.6％적라정재탁제과정중발생활사,이피외강판고정조환자무내치물격야병발증,병차소유환자균재문진무마취하순리취출내고정.과관절공능평정안조AOFAS평분MIPO조화피외강판고정조분별위(90.7±3.8)분화(88.9±4.1)분,량자지간차이무통계학의의.결론 MIPO기술화피외강판고정기술재경골원단골절적치료중도가이취득교만의적료효.단피외강판고정기술재수술시간、주원시간、골절유합시간、내치물격야급내고정취출방면구유명현우세.
Objective To compare the clinical efficacies of mini-invasive percutaneous osteosynthesis (MIPO) versus supercutaneous plating with closed reduction in the treatment of distal tibial fractures.Methods A total of 48 patients with close distal tibial fractures were treated between January 2010 and January 2012.The MIPO group included 16 males and 8 females with an average age of 36 years.And the types were A (n =15),B (n=6) and C (n=3) according to the classification scheme of Association for the Study of Internal Fixation (AO/ASIF).The supercutaneous plating group also included 16 males and 8 females with an average age of 37 years.And the types were A (n =15),B (n =6) and C (n =3).And the operative duration,hospital stay,union time,postoperative complications and function of ankle were compared between two groups.Results The mean follow-up period was 18.5 (12-26) months.There was no instance of nonunion,hardware breakdown or deep infection.Patients in supercutaneous plating group had significantly shorter mean operative duration,hospital stay and union time.Three patients and 1 patient in MIPO group presented with superficial infection and delayed union respectively while there was no occurrence in supercutaneous plating group.And the differences were not statistically significant.Fifteen patients (62.5％) complained of implant impingement or discomfort.And stripping occurred at an incidence of 15.6％ during the removal time of locking screws in MIPO group.While in supercutaneous plating group,there as no complaint of skin irritation and removal of supercutaneous plate was easily performed without anesthesia.The mean AOFAS score was 90.7 ± 3.8 in supercutaneous plating group versus 88.9 ± 4.1 in MIPO group (P =0.070).Conclusion Distal tibia fractures may be treated successfully with MIPO or supercutaneous plating.However,supercutaneous plating offers multiple advantages in terms of mean operative duration,hospital stay,union time,skin irritation and implant removal.