微创医学

【摘要】目的探讨锁定加压钢板结合经皮微创接骨术（LCPMIPPO）治疗胫骨下段骨折的临床疗效。方法120例闭合性胫骨下段骨折成人患者，按接受手术方法的不同分成LCPMIPPO组45例，切开复位钢板固定术（ORIF）组40例和单边外固定支架组35例。比较三组手术切口长度、手术时间、术中出血量、下地时间及临床愈合时间、并发症、优良率及术后AOFAS量表评分。结果110例均获得随访，时间为3～36个月，平均15.2个月。LCPMIPPO组较ORIF组术切口总长度短、术中出血量少、骨折临床愈合时间及负重下地时间短、并发症少、优良率及术后AOFAS量表评分高，差异有统计学意义（P＜0.05）；在手术时间、切口总长度、手术出血量比较，LCPMIPPO组与单边外固定支架组比较，差异无统计学意义（P＞0.05）；LCPMIPPO组较单边外固定支架固定组骨折临床愈合时间及负重下地时间短、并发症少、优良率及术后AOFAS量表评分高，差异有统计学意义（P＜0.05）。而手术所用时间三种方法无明显差异（P＞0.05）。结论LCPMIPPO治疗胫骨下段骨折是一种微创的手术方法，具有损伤小、固定可靠、愈合时间快并发症少的特点；而在局部软组织较差时，外固定支架也是一种不错的选择。

【Abstract】 ObjectiveTo explore the clinical efficacy of locking compression plate combined with minimally invasive percutaneous osteosynthesis (LCPMIPPO) for fracture of lower tibia. MethodsA total of 120 adult patients with closed fracture of lower tibia were divided into LCPMIPPO group (n=45), open reduction internal fixation(ORIF) group (n=40) and unilateral fixation with external fixator group (n=35) according to the surgical approaches. The length of incision, operation duration, intraoperative blood loss, duration of ambulation, duration for clinical recovery, incidence of complications, excellent rate and postoperative score of American Orthopaedic Foot and Ankle Society (AOFAS ) were compared among the three groups. ResultsFollowedup was performed in all cases, the average duration of followup was 15.2 months (range:3～36 months). In the LCPMIPPO group, the length of incision,intraoperative blood loss, duration for clinical fracture healing, duration for weightbearing walking and incident rate of complication were less or shorter, and excellent rate and postoperative AOFAS score were higher compared to the ORIF group (P＜0.05). There were no significant differences in the operation duration, length of incision and intraoperative blood loss between the LCPMIPPO group and unilateral fixation with external fixator group(P＞0.05). In the LCPMIPPO group, duration for clinical fracture healing, duration for weightbearing walking and incident rate of complication were less or shorter, and excellent rate and postoperative AOFAS score were higher compared to the unilateral fixation with external fixator group (P＜0.05). There was no significant difference in the operation duration among the three groups(P＞0.05). ConclusionLCPMIPPO is a minimally invasive surgical approach for fracture of lower tibia, and has the advantages of less trauma, reliable fixation, faster recovery and less complications. However, external fixator is also a good choice when the condition of local soft tissue is poor.