【摘要】：目的:本研究通過比較應(yīng)用專家型脛骨髓內(nèi)釘(Expert Tibial Nail,ETN)和經(jīng)皮微創(chuàng)鋼板(Minimally invasive percutaneous osteosynthesis,MIPPO)治療脛骨遠(yuǎn)端骨折的療效,對ETN治療脛骨遠(yuǎn)端骨折的療效進(jìn)行觀察分析,為臨床治療脛骨遠(yuǎn)端骨折提供參考。方法:本文選取了2009年到2013年延安大學(xué)附屬醫(yī)院骨科收治的98例脛骨遠(yuǎn)端骨折的患者進(jìn)行回顧性分析。其中51例脛骨遠(yuǎn)端骨折的患者采用了ETN閉合復(fù)位內(nèi)固定術(shù),47例患者采用了小切口經(jīng)皮微創(chuàng)鋼板螺釘內(nèi)固定術(shù)。通過比較兩種術(shù)式治療脛骨遠(yuǎn)端骨折的手術(shù)時間、術(shù)中出血量、術(shù)后負(fù)重時間、骨折愈合時間、術(shù)后的相關(guān)并發(fā)癥、患者術(shù)后恢復(fù)情況采用踝關(guān)節(jié)功能Kofoed評分及Johner-Wruhs的脛骨干骨折最終結(jié)果評定,進(jìn)行療效對比評價。將以上相關(guān)數(shù)據(jù)進(jìn)行統(tǒng)計學(xué)分析,統(tǒng)計結(jié)果以P0.05為差異有顯著性。結(jié)果:本研究共98例患者,所有的患者都獲得了6-18個月隨訪。98例脛骨遠(yuǎn)端骨折的患者都獲得了骨性愈合。經(jīng)ETN治療的脛骨遠(yuǎn)端骨折的患者手術(shù)時間為(93.24±22.53)min、出血量為(154.40±40.30)ml、術(shù)中X線透視次數(shù)(19.3±5.62)次;而采用MIPPO治療脛骨遠(yuǎn)端骨折的患者手術(shù)時間為(90.16±17.90)min、出血量為(168.42±38.50)ml、術(shù)中X線透視次數(shù)為(18.2±4.86)次,這些數(shù)據(jù)均無統(tǒng)計學(xué)差異(P0.05)。術(shù)后經(jīng)ETN治療的患者患肢完全負(fù)重時間為(8.50±1.50)周、骨性愈合時間為(19.2±3.2)周,采用MIPPO治療脛骨遠(yuǎn)端骨折的患者完全負(fù)重時間為(10.62±1.58)周、骨性愈合時間(24.8±8.9)周,即采用ETN治療脛骨遠(yuǎn)端骨折的患者的患肢完全負(fù)重時間和骨性愈合時間少于采用MIPPO治療的患者,二者有統(tǒng)計學(xué)差異,即P0.05。對術(shù)后采用的踝關(guān)節(jié)功能評分和脛骨骨干骨折的Johner-Wruhs結(jié)果評定方面進(jìn)行對比分析,ETN組和MIPPO組無統(tǒng)計學(xué)差異,即P0.05。結(jié)論:ETN是治療脛骨遠(yuǎn)端骨折比較理想的內(nèi)固定材料之一,它具有固定骨折牢靠,軟組織損傷小的特點(diǎn),完全適合于脛骨遠(yuǎn)端皮膚及軟組織條件較差的患者,它通過在距離踝穴較近的距離內(nèi)安放多枚多方向、多立體層面的鎖釘,使骨折遠(yuǎn)端穩(wěn)定,保護(hù)了骨折斷端血運(yùn),降低了骨折畸形愈合、延遲愈合及不愈合的發(fā)生率,是臨床上一種較理想的內(nèi)固定材料。
[Abstract]:Objective: to compare the therapeutic effects of expert tibial intramedullary nail (Expert Tibial Nail,ETN) and percutaneous minimally invasive plate (Minimally invasive percutaneous osteosynthesis,MIPPO) in the treatment of distal tibial fractures, and to observe and analyze the efficacy of ETN in the treatment of distal tibial fractures. To provide a reference for clinical treatment of distal tibial fractures. Methods: 98 cases of distal tibial fractures treated in Department of Orthopaedics, affiliated Hospital of Yan'an University from 2009 to 2013 were retrospectively analyzed. 51 cases of distal tibial fractures were treated with ETN closed reduction and internal fixation, and 47 cases were treated with small incision percutaneous minimally invasive plate screw fixation. The operative time, intraoperative bleeding, weight loading time, fracture healing time and postoperative complications were compared between the two methods for the treatment of distal tibial fractures. The postoperative recovery was evaluated by Kofoed score of ankle function and final result of tibial shaft fracture by Johner-Wruhs. Statistical analysis of the above related data, the statistical results with P0.05 as the significant difference. Results: 98 patients were followed up for 6 to 18 months. 98 patients with distal tibial fractures received bone healing. The operative time of the patients with distal tibial fractures treated with ETN was (93.24 鹵22.53) min, and (154.40 鹵40.30) ml,. The times of X-ray fluoroscopy were (19.3 鹵5.62) times. The operative time of the patients with distal tibial fractures treated with MIPPO was (90.16 鹵17.90) min, bleeding volume was (168.42 鹵38.50) ml, the times of X-ray fluoroscopy was (18.2 鹵4.86) times, there was no significant difference in these data (P0.05). The total weight loading time of the patients treated with ETN was (8.50 鹵1.50) weeks, the time of bone healing was (19.2 鹵3.2) weeks, and the time of complete weight loading was (10.62 鹵1.58) weeks in the patients with distal tibial fractures treated with MIPPO. The time of bone healing was (24.8 鹵8.9) weeks, that is, the time of full weight loading and bone healing in patients with distal tibial fractures treated with ETN was shorter than that in patients treated with MIPPO, and there was a statistical difference between the two groups (P0.05). There was no significant difference between ETN group and MIPPO group in ankle function score and Johner-Wruhs evaluation of tibial shaft fracture (P0.05). Conclusion: ETN is one of the ideal internal fixation materials for distal tibial fractures. It has the characteristics of reliable fixation and small soft tissue injury. It is fully suitable for patients with poor skin and soft tissue conditions of distal tibia. It can make the distal end of the fracture stable, protect the blood flow at the broken end of the fracture, and reduce the incidence of malunion, delayed healing and non-union by placing multiple multi-directional and multi-dimensional locking nails within a relatively close distance from the ankle point, so as to stabilize the distal end of the fracture. It is an ideal internal fixation material in clinic.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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