摘要
目的:比较微创经皮钢板固定术(MIPPO)与交锁髓内钉(IIN)内固定术治疗胫骨远端关节外骨折患者的效果。方法:回顾性分析2019年6月至2022年1月该院收治的106例胫骨远端关节外骨折患者的临床资料,按手术方式不同将其分为研究组与对照组各53例。对照组采用IIN内固定术治疗,研究组采用MIPPO治疗。比较两组手术相关指标水平,手术前后炎性因子[白细胞介素-1β(IL-1β)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]水平、骨代谢指标[β-胶原降解产物(β-CTX)、骨钙素(BGP)、骨形态发生蛋白-2(BMP-2)]水平,踝关节功能(Kofoed评分),以及并发症发生率。结果:研究组手术时间、住院时间均短于对照组,骨折愈合时间长于对照组,差异有统计学意义(P<0.05);两组术中出血量比较,差异无统计学意义(P>0.05);术后24 h,两组血清CRP、TNF-α、IL-1β水平均高于术前,但研究组低于对照组,差异有统计学意义(P<0.05);术后3个月,两组β-CTX水平均低于术前,但研究组高于对照组,两组BGP、BMP-2水平均高于术前,但研究组低于对照组,差异有统计学意义(P<0.05);术后1、6、12个月,两组Kofoed评分比较,差异均无统计学意义(P>0.05);研究组畸形愈合发生率低于对照组,差异有统计学意义(P<0.05)。结论:MIPPO治疗胫骨远端关节外骨折患者可缩短手术时间和住院时间,降低炎性因子水平和畸形愈合发生率,其效果优于IIN内固定术治疗,但会延长骨折愈合时间。
Objective:To compare the effects of minimally invasive percutaneous plate osteosynthesis(MIPPO)and interlocking intramedullary nail(IIN)internal fixation in treatment of patients with distal tibia extra-articular fractures.Methods:The clinical data of 106 patients with distal tibia extra-articular fractures admitted to the hospital from June 2019 to January 2022 were retrospectively analyzed.According to different surgical methods,they were divided into study group and control group,53 cases in each group.The control group was treated with IIN internal fixation,while the study group was treated with MIPPO.The levels of surgery-related indexes,inflammatory factors[interleukin-1β(IL-1β),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)]and bone metabolic factors[β-collagen degradation products(β-CTX),bone gla protein(BGP),bone morphogenetic protein-2(BMP-2)],the ankle function(Kofoed score),and the incidence of complications were compared between the two groups.Results:The operation time and the hospitalization time of the study group were shorter than those of the control group,the fracture healing time was longer than that of the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in intraoperative bleeding between the two groups(P>0.05).24 h after the surgery,the levels of serum CRP,TNF-αand IL-1βin the two groups were higher than those before the surgery,but those in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).3 months after the surgery,the levels ofβ-CTX in the two groups were lower than those before the surgery,but that in the study group was higher than that in the control group;the levels of BGP and BMP-2 in the two groups were higher than those before the surgery,but those in the study group were lower than those in the control group;and the difference was statistically significant(P<0.05).There were no significant differences in Kofoed score between the two groups 1,6 and 12 months after the surgery(P>0.05).The incidence of malunion in the study group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusions:MIPPO in the treatment of the patients with distal tibia extra-articular fractures can shorten the operation time and the hospitalization time,reduce the levels of inflammatory factors and the incidence of malunion.It is superior to IIN internal fixation,but the fracture healing time needs to be prolonged.
作者
贾炳胜
JIA Bingsheng(4^(th) Department of Orthopedics of Nanyang City Hospital of Traditional Chinese Medicine,Nanyang 473003 Henan,China)
出处
《中国民康医学》
2024年第8期135-137,141,共4页
Medical Journal of Chinese People’s Health
关键词
微创经皮钢板固定术
交锁髓内钉内固定术
胫骨远端关节外骨折
骨折愈合
骨代谢
炎性因子
Minimally invasive percutaneous plate fixation
Interlocking intramedullary nail internal fixation
Distal tibial extra-articular fracture
Fracture healing
Bone metabolism
Inflammatory factor
