经皮微创与开放手术治疗胫骨远端骨折的疗效分析

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(P0.05)。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。

Treatment of Distal Tibial Fracture with Percutaneous Minimally Invasive and Open Surgery

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.