Interlocking intramedullary nail versus minimally invasive percutaneous plate internal fixation in the treatment of middle or lower tibial fractures
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摘要:目的 探讨交锁髓内钉(IMN)和微创经皮钢板内固定术(MIPPO)治疗胫骨中下段骨折的手术效果差异。方法 选取80例胫骨中下段骨折患者，采用随机数表法分为IMN组和MIPPO组，各40例，术后均门诊随访6个月。比较2组手术及住院基本指标、骨折愈合时间和手术并发症发生情况，并采用Johner-Wruhs评分系统评估术后踝关节功能。结果 2组住院时间、骨痂生成时间和骨折愈合时间比较，差异无统计学意义(P>0.05); MIPPO组的手术时间(63.28±9.75) min、手术出血量(87.32±16.42) mL, 优于IMN组(71.16±11.23) min、(102.58±20.37) mL, 差异有统计学意义(P < 0.05); 2组术后均成功随访6个月，未出现畸形愈合和内固定失败病例, IMN组、MIPPO组的手术并发症发生率分别为10.00%、12.50%, 组间差异无统计学意义(P>0.05); 术后Johner-Wruhs评分显示, IMN组、MIPPO组的踝关节功能优良率分别为90.00%、92.50%, 组间差异无统计学意义(P>0.05)。结论 IMN和MIPPO均是治疗胫骨中下段骨折的有效内固定疗法，在住院时间、骨折愈合、手术并发症及踝关节功能恢复方面相近，但MIPPO具有缩短手术时间和减少出血量的微创优势。Abstract:Objective To investigate the difference of surgical effect between intramedullary nail (IMN) and minimally invasive percutaneous plate osteosynthesis(MIPPO) in the treatment of middle or lower tibial fractures.Methods A total of 80 patients with middle or lower tibial fractures admitted to our hospital were divided into IMN group (n=40) and MIPO group (n=40) according to radom table methal. All patients were followed up for 6 months in outpatient department. The indexes of operation and hospitalization, fracture healing time and surgery-related complications were compared between the two groups. Johner-Wruhs scoring system was used to evaluate ankle function after operation.Results There were no significant differences in hospitalization time, callus formation time and fracture healing time between the two groups (P>0.05). The operation time and bleeding volume were (63.28±9.75) min, (87.32±16.42) mL, respectively, in MIPPO group, which were better than (71.16±11.23) min and (102.58±20.37) mL, respectively in IMN group(P < 0.05). All the patients were successfully followed up for 6 months, and no cases with malunion and internal fixation failure occurred. The complication rates of IMN group and MIPPO group were 7.50% and 12.50% respectively, and showed no significant difference between the two groups (P>0.05). Postoperative Johner-Wruhs scoring showed that the excellent recovery rate of ankle joint function in IMN group and MIPPO group was 90.00% and 92.50%, respectively, showing no significant difference between the two groups (P>0.05).Conclusion Both IMN and MIPPO are effective internal fixation for the treatment of middle and lower tibial fractures, and have similar effects in hospitalization time, fracture healing, surgical complications and recovery of ankle function. However, MIPPO has the advantage of shortening the operation time and reducing the amount of bleeding.
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表 1 2组手术住院指标及骨折愈合指标比较(x±s)
组别 n 手术时间/min 手术出血量/mL 住院时间/d 骨折愈合时间/d IMN组 40 71.16±11.23 102.58±20.37 14.75±2.97 131.47±13.70 MIPPO组 40 63.28±9.75* 87.32±16.42* 14.53±3.02 128.95±12.86 IMN: 交锁髓内钉; MIPPO: 微创经皮钢板内固定术。与IMN组比较, *P＜0.05。 
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表 2 2组并发症发生情况比较[n(%)]
组别 n 切口感染 切口皮肤坏死 膝关节疼痛 延迟愈合 合计 IMN组 40 0 1(2.50) 2(5.00) 1(2.50) 4(10.00) MIPPO组 40 2(5.00) 2(5.00) 1(2.50) 0 5(12.50) IMN: 交锁髓内钉; MIPPO: 微创经皮钢板内固定术。
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表 3 2组术后6个月踝关节功能比较[n(%)]
组别 n 优 良 可 差 优良 IMN组 40 21(52.50) 15(37.50) 4(10.00) 0 36(90.00) MIPPO组 40 23(57.50) 14(35.00) 3(7.50) 0 37(92.50) IMN: 交锁髓内钉; MIPPO: 微创经皮钢板内固定术。
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