胫骨远端骨折:经皮钢板内固定优于切开复位内固定吗?

目的 对闭合复位经皮钢板固定及切开复位内固定两种方法治疗胫骨远端骨折进行回顾性比较研究,明确两种方法的不同指征和疗效. 方法 2006年10月至2007年6月,对采用钢板内固定治疗闭合胫骨远端骨折(不累及关节面)的94例患者进行回顾性研究.研究对象分为切开组和闭合组,其中切开组42例,闭合组52例.研究内容为骨折愈合时间、有无畸形愈合及并发症发生率.结果 平均随访时间14.5个月(8～24个月).切开组中骨折愈合35例,延迟愈合3例,骨不连4例.平均愈合时间3.83个月(3～8个月),无畸形愈合患者,切口感染2例.闭合组中骨折愈合47例,延迟愈合5例,无骨不连患者.平均愈合时间3.66个月(2～8个月).两组的总愈合时间,A1型、A2型、B型愈合时间之间差异无统计学意义;A3型愈合时间闭合组长于切开组;C型愈合时间闭合组短于切开组.闭合组中出现5例畸形愈合患者(其中2例外旋畸形,3例向后成角畸形),8例出现踝关节异物不适感,钢板取出后症状好转. 结论胫骨远端骨折总体上切开组与闭合组的愈合时间差异无统计学意义.但A3型骨折中切开组要优于闭合组,而C型骨折中闭合组要优于切开组.如闭合复位经皮固定的患者术后存在前后成角畸形,则其存在较高的骨延迟愈合率.

Is percutaneous plate fixation better than ORIF for distal tibial fractures

Objective To compare the clinical results of minimally invasive percutancous plate os-teosynthesis (MIPPO) and open reduction with internal fixation (ORIF) for treatment of distal tibial fractures. Methods From October 2006 to June 2007, 94 cases of closed distal tibial fracture with intact articular surface were treated by internal fixation with plates. Of them, 42 were treated with ORIF and 52 with MIPPO. We retrospectively analyzed their union time, malunion and complications. Results The average follow-up was 14.5 (8 to 24) months. In the ORIF group, 35 cases got union, 3 cases delayed union and 4 cases nonunion. The average time for union was 3.83 (3 to 8) months. There were no cases of malunion and 2 cases of superficial infection in this group. In the MIPPO group, 47 cases obtained union, 5 cases delayed union and none nonunion. The average time for union was 3.66(2 to 8) months. No significant differences were found between the 2 groups in total union time or in the union time for Type AI, Type A2 and Type B fractures respectively. The union time for Type A3 fracture was longer in the MIPPO group than in the ORIF group, but the union time for Type C fracture in the MIPPO group was shorter than in the ORIF group. In the MIPPO group, external rotation occurred in 2 cases and posterior angnlation displacement in 3, and 8 cases com-plained of discomfort around the ankle which was relieved after removal of the plate. Conclusions Gen-erally speaking, there is no significant difference between ORIF and MIPPO in union time for distal tibial fractures. ORIF may be superior to MIPPO in treatment of Type A3 fracture, but inferior to MIPPO in treatment of Type C fracture. A high rate of delayed union may be expected in patients who have been treated with MIPPO and have had anteroposterior angnlation.