微创及切开复位接骨板内固定治疗膝关节内骨折比较.docVIP

微创及切开复位接骨板内固定治疗膝关节内骨折比较 　【摘要】 比较研究微创接骨板内固定和切开复位接骨板内固定对膝关节内骨折的治疗效果，探讨生物学内固定在膝关节内骨折中的使用价值。［方法］总结近年来根据生物学固定原则，以微创接骨板固定术(MIPO)治疗的膝关节内骨折共21例。以创伤类型及年龄等因素进行配对，选择切开复位内固定(ORIF)治疗的病例资料比较手术及术后恢复情况。采用HSS评分评价结果。［结果］MIPO组随访10～16个月(平均14.2个月)，有2例进行骨移植术，平均手术时间60.0 min，术中失血量45.0 ml，平均骨折愈合时间10.0周，3例有5°以上膝内、外翻畸形，HSS功能评分平均86.67分；ORIF组经过12～48个月(平均21.2个月)随访，有18例进行骨移植术，平均手术时间79.52 min，平均术中失血量117.1 ml，平均骨折愈合时间12.24周，2例发生5°以上膝关节内、外翻畸形，HSS功能评分平均82.14分。两组均获得骨愈合，没有感染和内固定断裂等并发症发生。比较发现两组患者在手术时间、术中失血量、骨折愈合时间和功能恢复方面差异有统计学意义。［结论］对于合适的膝关节内骨折病例以微创接骨板内固定治疗可以降低植骨需求和术中失血，在手术过程和术后恢复方面有明显优势。 【关键词】 膝关节 骨折固定术 间接复位 生物学固定 Abstract：［Objective］To comparatively analyze the clinical results of minimally invasive plate osteosynthesis (MIPO) and ORIF in treatment of intra-articular fracture of knee joint and to investigate the utilization value of biological fixation.［Method］According to the principles of conservation of the vascularity,21 cases of intra-articular fractures of knee joint underwent surgical treatment of MIPO in recent years.In accordance with the type of fracture and other anticipated factors influenced bony healing,paired-samples treated of ORIF were selected.The two groups were compared following: operation time,intra-operative blood loss,bone union time,axial malalignment radiologically of knee joint,and the ROM of knee.HSS criteria were used to evaluate the results.［Result］In MIPO group,all 21 fractures were followed up for averagely 14.2 months (range 10～16 months).The mean duration of surgery was 60.0 min (range 50～70 min) and bone grafting underwent in 2 cases.Complete fracture healing was achieved with the average time of 10.0 weeks and assessment of vallgus/varus alignment showed a deviation more than 5 degrees in 3 cases.The average HSS score was 86.67.In ORIF group,all 21 fractures were followed up for averagely 21.2months (range 12～48 months).The mean duration of surgery was 79.52 min (range 65-95 min) and bone grafting underwent in 18 cases.Complete fracture healing was achieved with t