【摘要】 目的比较经皮微创接骨板内固定技术(minimally invasive percutaneous plate osteosynthesis,MIPPO)与有限切开结合MIPPO技术治疗胫骨远端1/3关节外骨折的临床疗效。方法回顾性分析2015年1月～2018年12月我院胫骨远端关节外骨折77例,MIPPO组25例,有限切开结合MIPPO组52例,随访1年以上。比较2组术中透视次数、术后正位踝穴角、无痛负重时间、骨折愈合时间、末次随访时踝关节屈伸活动度、美国足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)评分及并发症。结果 MIPPO组较有限切开结合MIPPO组术中透视次数平均增加约2次[(10.5±2.4)次vs.(8.7±2.5)次,t=2.845,P=0.006]。随访时间(20.3±6.6)月。2组各1例局部蜂窝组织炎(P=0.547)。MIPPO组1例内固定断裂术后1个月行翻修手术(P=0.325)。2组正位踝穴角、无痛负重时间、骨折影像学愈合时间、末次随访时踝关节屈伸活动度及AOFAS评分差异无统计学意义(P>0.05)。结论有限切开复位能直视确保复位质量,且不增加切口相关并发症,同时减少医患放射线暴露,是治疗胫骨远端1/3关节外骨折的安全、有效方法。更多还原

【Abstract】 Objective To compare the clinical and radiological results between minimally invasive percutaneous plate osteosynthesis(MIPPO) and limited open reduction combined with MIPPO in the treatment of distal 1/3 tibial extraarticular fracture.Methods A retrospective analysis was conducted on 77 cases of distal tibial extraarticular fractures treated in our hospital from January 2015 to December 2018. There were 25 cases treated with MIPPO and 52 cases treated with limited open reduction combined with MIPPO. All the patients were followed up for more than 1 year. The times of intraoperative fluoroscopy, angle of ankle, painless weight bearing time, fracture union time, flexion and extension of ankle joint and American Orthopedic Foot and Ankle Society(AOFAS) score at the last follow-up and complications were compared between the two groups. Results Compared with the limited open reduction combined with MIPPO group, the times of intraoperative fluoroscopy in the MIPPO group was increased by about 2 times on average, with difference being statistically significant [(10.5±2.4) vs.(8.7±2.5) times, t=2.845, P=0.006]. All the 77 patients were followed up for at least one year, with an average of(20.3±6.6) months. One patient in each group had local cellulitis(P=0.547), which was improved and well controlled by intravenous antibiotics and local dressing change. In the MIPPO group, one patient underwent revision surgery 1 month post-operation because of the failure of internal fixation due to early weight-bearing(P=0.325). There was no significant difference between the two groups in the angle of ankle, painless weight-bearing time, fracture union time, ankle flexion and extension activity and AOFAS score at the last follow-up(P>0.05). Conclusion Limited open reduction combined with MIPPO can ensure the quality of reduction and reduce the radiation exposure of patients and doctors. It is a safe and effective method for the treatment of the distal 1/3 tibial extraarticular fractures.更多还原