微创经皮接骨板技术术中双反牵引复位在胫骨中远段粉碎性骨折中的应用效果分析

doi:10.3969/j.issn.1005-6483.2019.07.019

摘要/Abstract

摘要： 目的：探讨胫骨中远段粉碎性骨折病人经微创经皮接骨板技术(MIPPO)术中双反牵引复位的应用效果。方法：84例胫骨中远段粉碎性骨折病人随机分为观察组与对照组，每组42例。两组均实施MIPPO，观察组术中使用双反牵引复位，对照组常规复位内固定。比较两组围手术期情况，评价骨折复位情况、下肢功能、踝关节功能及骨折移位参数。结果：观察组的手术时间、术中出血量、有限切开率、术后负重时间、骨折愈合时间显著优于对照组（P<0.05），解剖复位效果优于对照组（P<0.05）。观察组远折段内移外移长度和前后移长度、远折段内外翻角度、近端环左右和前后偏移量均明显降低（P<0.05），且均优于对照组（P<0.05）。术后3、6、12个月，观察组的JohnerWruhs和 AOFASAHS评分均高于对照组（P<0.05）。两组并发症发生率比较差异无统计学意义（P>0.05）。结论：MIPPO术中双反牵引复位治疗胫骨中远段粉碎性骨折复位满意，有利于骨折愈合及下肢功能康复。

关键词: 胫骨骨折, 粉碎性骨折, 微创经皮接骨板内固定, 双反牵引

Abstract: Objective：To investigate the application effect of doublereverse traction reset and fixation with MiPPO for patients with comminuted fractures of middle and distal tibia.Methods：84 patients with comminuted fractures of middle and distal tibia were randomly divided into observation group and control group, with 42 cases in each group. Both groups underwent MIPPO,the observation group was treated with doublereverse traction reset and fixation,the control group was treated with conventional reset and fixation. The perioperative conditions were compared between the two groups,the eduction of fracture,the lower extremity function, ankle function and fracture displacement parameters were evaluated.Results：The operation time, intraoperative blood loss,limited incision rate , postoperative weightbearing time and fracture healing time were significantly lower than the control group(P<0.05),the reduction effect of the observation group was better than that of the control group (P<0.05).The length of the distal movement and distal segment, the inner and outer angle,left and right offset of the proximal ring, and the offset of the proximal ring were significantly reduction (P<0.05), which were better than the control group(P<0.05). At 3, 6, and 12 months after operation, the JohnerWruhs and AOFASAHS scores in the observation group were significantly higher than those in the control group(P<0.05). There was no significant difference in the complication rate between the observation and control group(P>0.05).Conclusion：Doublereverse traction reset and fixation with MiPPO for patients with comminuted fractures of middle and distal tibia can achieve satisfactory reduction, it is beneficial for fracture healing and rehabilitation of lower limb function.

Key words: tibia fracture, comminuted fractures, minimally invasive percutaneous plate osteosynthesis, doublereverse traction

李迎全, 陈多军, 王飞等. 微创经皮接骨板技术术中双反牵引复位在胫骨中远段粉碎性骨折中的应用效果分析[J]. 临床外科杂志, 2019, 27(7): 600-602.

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