胫骨中下段骨折的微创经皮钢板与切开复位内固定疗效比较

目的比较微创经皮钢板和切开复位内固定对胫骨中下段骨折的疗效。方法选择2009年2月～2012年2月北京中医药大学东方医院收治的胫骨中下段骨折患者54例临床资料进行回顾性分析。根据手术方式不同,分为切开组及微创组,切开组27例接受切开复位钢板固定方法治疗,微创组27例接受微创经皮钢板内固定法治疗。比较两组患者手术时间、术中出血量、骨折愈合时间,并做预后Johner-Wruhs分级。结果两组手术时间（59.5±5.9）、（58.8±5.8）min]比较,差异无统计学意义（P〉0.05）;微创组患者术中出血量（35.1±7.1）mL]明显少于切开组（71.4±10.6）mL],术后骨折愈合时间微创组（10.1±2.5）周]明显短于切开组（14.3±4.7）周],差异有统计学意义（P〈0.05）;预后Johner-Wruhs分级微创组优良率85.2%（23/27）]明显高于切开组51.8%（14/27）],差异有统计学意义（P〈0.05）。结论微创经皮钢板内固定法遵循生物力学原则,保护骨折局部血运,是治疗胫骨中下段骨折理想的内固定方法。

Efficacy comparison of minimally invasive percutaneous plate and open reduction internal fixation in treatment of middle and distal tibia fracture

Objective To compare the difference between minimally invasive percutaneous plate and open reduction internal fixation in the treatment of middle and distal tibia fracture.Methods The clinical data of 54 cases of middle and distal tibia fracture during February 2009 to February 2012 in Dongfang Hospital of Beijing University of Chinese Medicine were selected and investigated retrospectively.All the patients were divided into incision group and minimally invasive group according to their surgical procedures.27 patients in incision group were treated with open reduction internal fixation,27 patients in minimally invasive group were treated with minimally invasive percutaneous plate internal fixation.Time of operation,intraoperatve blood loss,fracture healing time were compared between the two groups;Johner-Wruhs prognosis grades were recorded.Results The difference of time of operation in the two groups （59.5±5.9）,（58.8±5.8） min] was not statistically significant（P 0.05）;intraoperatve blood loss in minimally invasive group （35.1±7.1） mL] were lower than those in incision group （71.4 ±10.6）mL],fracture healing time after the opera tion in minimally invasive group （10.1 ±2.5） week] were shorter than those in incision group （14.3 ±4.7） week],the differences were all statistically significant（P 0.05）;the excellent rate of Johner-Wruhs prognosis grades in minimally invasive group 85.2%（23/27）] were better than those in incision group 51.8%（14/27）],the difference was statistically significant（P 0.05）.Conclusion Minimally invasive percutaneous plate internal fixation follows the biological mechanics principle and rrotects the local blood supply,it is the right internal fixation treatment for middle and distal tibia fracture.