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手法闭合复位经皮微创固定治疗胫骨中下段骨折的病例对照研究
Hits: 2309   Download times: 1796   Received:March 09, 2014    
作者Author单位UnitE-Mail
刘印文 LIU Yin-wen 上海中医药大学附属曙光医院石氏伤科医学中心, 上海 200021 Shi's Center of Orthopaedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 200021, China  
郑昱新 ZHENG Yu-xin 上海中医药大学附属曙光医院石氏伤科医学中心, 上海 200021 Shi's Center of Orthopaedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 200021, China  
王学宗 WANG Xue-zong 上海中医药大学附属曙光医院石氏伤科医学中心, 上海 200021 Shi's Center of Orthopaedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 200021, China  
张琥 ZHANG Hu 上海中医药大学附属曙光医院石氏伤科医学中心, 上海 200021 Shi's Center of Orthopaedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 200021, China  
孙慕政 SUN Mu-zheng 上海中医药大学附属曙光医院石氏伤科医学中心, 上海 200021 Shi's Center of Orthopaedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 200021, China  
卫晓恩 WEI Xiao-en 上海中医药大学附属曙光医院石氏伤科医学中心, 上海 200021 Shi's Center of Orthopaedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 200021, China  
顾新丰 GU Xin-feng 上海中医药大学附属曙光医院石氏伤科医学中心, 上海 200021 Shi's Center of Orthopaedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 200021, China  
匡勇 KUANG Yong 上海中医药大学附属曙光医院石氏伤科医学中心, 上海 200021 Shi's Center of Orthopaedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 200021, China  
张磊 ZHANG Lei 上海中医药大学附属曙光医院石氏伤科医学中心, 上海 200021 Shi's Center of Orthopaedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 200021, China  
沈孜良 SHEN Zi-liang 上海中医药大学附属曙光医院石氏伤科医学中心, 上海 200021 Shi's Center of Orthopaedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 200021, China  
詹红生 ZHAN Hong-sheng 上海中医药大学附属曙光医院石氏伤科医学中心, 上海 200021 Shi's Center of Orthopaedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 200021, China shgsyjs@139.com 
石印玉 SHI Yin-yu 上海中医药大学附属曙光医院石氏伤科医学中心, 上海 200021 Shi's Center of Orthopaedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of TCM, Shanghai 200021, China  
期刊信息：《中国骨伤》2015年28卷，第3期，第230-234页
DOI：10.3969/j.issn.1003-0034.2015.03.009
基金项目:“中医骨伤科学”国家重点学科(编号:100508);海派中医流派传承基地项目(编号:ZYSNXD-CC-HPGC-JDD-001);上海领军人才项目(编号:041);上海市中医药三年行动计划项目(编号:ZY3-DCCX-3-3004);上海市卫生和计划生育委员会中医药科研基金(编号:2014LP096A)


目的:采用手法闭合复位结合MIPPO技术经皮锁定接骨板固定与常规小腿下段前外侧入路切开复位内固定治疗胫骨中下段骨折,比较两种方法的临床效果。

方法:2009年3月至2013年5月,治疗并获得随访的124例胫骨中下段骨折,其中男89例,女35例;左侧53例,右侧71例;年龄21～81岁,平均(48.62±8.93)岁;摔伤94例,车祸伤30例。微创组66例,男48例,女18例;平均年龄(47.72±9.23)岁;29例合并腓骨(或外踝)骨折;根据AO分型,A型45例,B型12例,C型9例;受伤至手术时间平均1.9 d;采用手法闭合复位技术结合MIPPO治疗。常规组58例,男41例,女17例;平均年龄(49.08±9.66)岁;26例合并腓骨(或外踝)骨折;根据AO分型,A型41例,B型10例,C型7例;受伤至手术时间平均2.3 d;采用常规小腿下段前外侧入路切开复位内固定治疗。所有患者为闭合性骨折。

结果:微创组手术切口(7.34±1.42) cm,常规组(21.82±2.35) cm,微创组较常规组切口小;微创组手术时间(44.48±10.00) min,常规组(59.42±11.84) min,微创组手术时间较常规组短。随访时间10～24个月,平均15.2个月。微创组65例在术后15～20周骨折愈合,1例发生骨折延迟愈合,予补肾续骨中药口服后愈合,术后均未出现伤口处表皮感染、皮肤裂开及骨外露;常规组4例出现伤口裂开、感染,致钢板外露,3例出现骨不连并再次手术,其余骨折均愈合良好。随访过程中未出现钢板及螺钉松动、断裂及骨折再移位等现象。按照Johner-Wruhs功能评定标准,微创组疗效优于常规组。

结论:手法闭合复位结合MIPPO技术治疗胫骨中下段骨折,结合了传统正骨手法与现代骨科的优点,既保护了软组织,将手术程序简化,创伤降到最小,又能获得较坚强的内固定,保证踝关节的早期功能活动,具有软组织创伤小、血运破坏少、固定可靠等优点,是治疗胫骨中下段骨折的一种有效方法,也符合微创生物学内固定观点。
[关键词]:胫骨骨折  骨折固定术,内  手法,骨科  病例对照研究
 
Case-control study on close reduction combined with minimally invasive percutaneous plate osteosynthesis for the treatment of distal fracture of tibial shaft
Abstract:

Objective:To compare the effects of close reduction combined with minimally invasive percutaneous plate osteosynthesis for distal fracture of tibial shaft.

Methods:From March 2009 to May 2013,there were 124 patients (89 males and 35 females,30 of them were injured in a traffic accident and 94 were falling down in daily life,the ages ranging from 21 to 81 years old) who suffered from distal fracture of tibial shaft. Sixty-six patients(48 males and 18 females,45 cases of type A,12 cases of type B and 9 cases of type C) were treated with close manipulative reduction combined with minimally invasive percutaneous plate fixation. After close reduction,a minimal incision was made and a anatomic plate was inserted just along the medial tibia periostea,and then the fracture was fixed without fracture exposure. The other 58 patients(41 males and 17 females,41 cases of type A,10 cases of type B and 7 cases of type C) were treated with conventional open reduction and internal fixation. Length of the incision,operating time,early postoperative pain(recorded using the Visual Analog Scale score) and the outcome results(recorded using the evaluation standard of Johner-Wruhs) were compared.

Results:The length of incision was meanly(7.34±1.42) cm in MIPPO group and(21.82±2.35) cm in ORIF group; operation time was (44.48±10.00) min in MIPPO group and (59.42±11.84) min in ORIF group. The postoperative radiographs verified good position of all screws and satisfactory bone fracture reduction in both groups. All the patients were followed up,and the duration ranged from 10 to 24 months (mean 15.2 months) in both groups. In MIPPO group,only one patient had delayed union and got union after Chinese herb therapy. The other 65 patients got bony union during 15 to 20 weeks. While in ORIF group,3 patients suffered from nonunion and received reoperation with bone grafting,and 4 patients got bone infection.

Conclusion:Treatment of distal fracture of tibial shaft,combined with close reduction and MIPPO technique,has the advantages such as less invasion,less damage of blood supply,simplified procedure of operation and higher union rate,which is an ideal methods and is accordant to the biological demand.
KEYWORDS:Tibial fractures  Fracture fixation,internal  Manipulation,orthopedic  Case-control studies
 
引用本文，请按以下格式著录参考文献：
中文格式:刘印文,郑昱新,王学宗,张琥,孙慕政,卫晓恩,顾新丰,匡勇,张磊,沈孜良,詹红生,石印玉.手法闭合复位经皮微创固定治疗胫骨中下段骨折的病例对照研究[J].中国骨伤,2015,28(3):230~234
英文格式:LIU Yin-wen,ZHENG Yu-xin,WANG Xue-zong,ZHANG Hu,SUN Mu-zheng,WEI Xiao-en,GU Xin-feng,KUANG Yong,ZHANG Lei,SHEN Zi-liang,ZHAN Hong-sheng,SHI Yin-yu.Case-control study on close reduction combined with minimally invasive percutaneous plate osteosynthesis for the treatment of distal fracture of tibial shaft[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(3):230~234
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