四柱分型理论下MIPPO技术治疗老年胫骨平台骨折的临床观察

目的 探讨在四柱分型理论指导下应用MIPPO(minimally invasive percutaneous plate osteosynthesis)技术联合抗骨质疏松等治疗老年胫骨平台骨折的临床疗效。 方法 选取自2014年1月-2015年8月苍南县第二人民医院和浙江省中医院骨科收治的60例老年胫骨平台骨折患者,按照随机数字表均分为2组。对照组使用传统切开复位内固定术,研究组在四柱分型理论指导下应用MIPPO技术内固定,2组围手术期均给予抗骨质疏松和抗感染等治疗。观察比较2组患者胫骨平台内翻角(TPA)、胫骨平台后倾角(PA)、股胫角(FTA)、膝关节活动度、切口长度、术中出血量、引流量、骨折愈合、骨密度改善情况、视觉模拟评分法(visual analogue scale,VAS)、膝关节功能评分、并发症发生率等临床指标。 结果 研究组治疗后膝关节活动度[(119.36±6.47)°]、膝关节功能评分[(HSS评分,85.39±9.86)分]、骨折愈合情况[(3.12±0.64)个月]、术中出血量[(62.63±9.58)ml]、切口长度[(5.17±1.89)cm]、手术并发症发生率(6.7%)等方面优于对照组,差异有统计学意义(P<0.05)。2组TPA、PA、FTA等方面比较,差异没有统计学意义(P>0.05)。 结论 四柱分型理论指导下应用MIPPO技术治疗老年胫骨平台骨折,具有创伤小、骨折复位良好、内固定稳定持久、关节功能恢复良好和并发症少等优点,临床疗效好,值得推广。 

Clinical observation of combing the four column classification theory with minimally invasive percutaneous plate osteosynthesis in treatment of senile tibial plateau fractures

Objective To evaluate the clinical effect of combing the four column classification theory with minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and anti-osteoporosis in the treatment of senile tibial plateau fractures. Methods From January, 2014 to August, 2015, sixty patients with tibial plateau fractures in our hospital were enrolled and randomly divided into two groups (n=30). The control group received the open reduction and internal fixation, while the research group received four column classification theory and MIPPO technique. Anti-osteoporosis and infection treatment were used during the peroperative period. The tibial plateau angle, posterior tibial plateau angle, femoral tibial angle, knee joint, incision length, intra operative hemorrhage, fracture healing, bone density improvement, visual analogue scale, knee joint function score, complication rate so on operation index were compared between the two groups. Results The knee joint (119.36±6.47) °, HSS[(85.39±9.86) scores], fracture healing[(3.12±0.64) months], intra operative hemorrhage[(62.63±9.58) ml], incision length[(5.17±1.89) cm], complication rate (6.7%) in the research group were better than those in the control group, the differences were statistically significant (P<0.05). The differences in TPA, PA and FTA between the two groups were no statistically significant (P>0.05). Conclusion Combing the four column classification theory with MIPPO technique in the treatment of senile tibial plateau fractures had advantages of less trauma, good reduction, stable and durable internal fixation, good joint function recovery and fewer complications. The effect was good, and it was worth popularizing.