摘要
目的:探讨在双反牵引辅助下闭合复位胫骨平台骨折并应用MIPPO技术内固定的临床治疗效果.方法:回顾性分析我院2017年6月-2019年6月收治的胫骨平台骨折患者29例,其中男性15例,女性14例,年龄23-76岁,平均年龄(51.39±13.21)岁,致伤原因:其中车祸伤8例,高空坠落伤3例,骑车摔到致伤17例,平地跌倒1例;术前采用X线摄片及CT检查确诊为胫骨平台骨折,并根据X线片进行Schatzker分型,其中I型1例,II型9例,III型3例,IV型4例,V型1例,VI型11例.其中实施传统切开复位内固定术17例,双反牵引下闭合复位应用MIPPO技术内固定术12例.传统手术组纳入传统手术切开复位内固定病例,选择前外侧,前内侧或后内侧切口,或双切口联合入路,显露骨折端,直视下撬拔复位,钢板螺钉内固定.观察组纳入病例采用双反牵引下闭合复位,通过骨隧道通道微创复位塌陷骨折块后取髂骨条植骨,应用MIPPO技术,小切口插入钢板后内固定.术中透视并术后行X线摄膝关节正侧位片验证复位效果,比较手术耗时,术中出血量,观察术后并发症等,其中3例出现术后切口感染,均为实施传统手术病例,微创手术病例无切口感染.术后1个月,2个月,3个月,半年门诊随访,行X线检查,并进行HSS评分,记录数据.所有数据用SPSS21.0统计及分析.结果:观察组的平均手术时间比对照组手术时间更少;术后4周的HSS评分高于对照组;但术中出血量和末次随访的膝关节HSS评分差异无统计学意义.结论:双反牵引下应用MIPPO技术微创治疗胫骨平台骨折相对于传统手术有明显优势.
Objective:To investigate the clinical effect of closed reduction of tibia plateau fracture with a rapid reductor and internal fixation with MIPPO technique.Methods:To analyze retrospectively 29 patents of tibia plateau fracture from June 2017 to June 2019 in our hospital,including 15 males and 14 females,aged 23 to 76 years with an average age of(51.39±13.21)years.There were 8 patents injured in a traffic accident,3 patents injured in the falling accident,17 falling down when riding a motorcycle and 1 falling down on the walk.All of the patents were made a definite diagnosis by X-ray and CT before operation,and Schatzker classification was performed according to X-ray,including 1 case of type I,9 of type II,3 of type III,4 of type IV,1 of type V and 11 of type VI.Among them,17 cases were treated with traditional open reduction and internal fixation,and 12 cases were treated with a rapid reductor assisted and MIP_PO technique.In the traditional operation group,the cases of open reduction and internal fixation were included.The anterior lateral,anterior medial or posterior medial incisions,or double incision combined operative approach were selected to expose the fracture,pry bone block to reduce the fracture under direct vision and make internal fixation with plate and screw.In the minimally invasive operation group,the patients were treated with closed reduction with a rapid reductor assisted,minimally invasive reduced the collapse of bone block of tibia fracture through bone tunnel,and then grafted bone with ilium strips.Make a small incision and insert a plate to fix the tibia fracture.The reduction effect was verified by X-ray during and after operation,the operation time and the amount of bleeding during operation was compared,the postoperative complications were observed.Among them,3 cases had incision infection which were performed traditional operation,and no incision infection was found in minimally invasive surgery.The patient was seen for follow-up visits in 1 month,2 months,3 months and 6 months after operation,had X-ray examination,HSS score and data were recorded.All of the data were statistically analyzed by SPSS21.0.Results:The mean operating time of the minimally invasive operation group was less than that of the other group,and the HSS score at 4 weeks after operation was higher.But there was no significant difference in the amount of intraoperative bleeding and the HSS score in the last follow-up.Conclusions:Compared with traditional surgery,The minimally invasive treatment of tibia plateau fracture with a rapid reductor assisted and MIPPO technique has obvious advantages.
作者
陈锐
林世磅
黄海舟
CHEN Rui;LIN Shi-bang;HUANG Hai-zhou(Department of Orthopedic Trauma,Maoming Hospital,Maoming Guangdong 525000)
出处
《中国伤残医学》
2020年第22期6-10,共5页
Chinese Journal of Trauma and Disability Medicine
关键词
胫骨平台骨折
双反牵引
MIPPO
微创
内固定
tibia fracture
rapid reductor
MIPPO
minimally invasive treatment
internal fixation
