摘要
目的 对比不同入路下微创经皮内固定(Minimally invasive percutaneous plate osteosynthesis,MIPPO)治疗远端胫腓骨骨折(Fracture of tibia and fibula,OTFF)患者的效果.方法 选取2020年1月-2022年10月收治的78例远端OTFF患者,按随机数字表法分成A组(n=39)、B组(n=39).两组均行MIPPO治疗,A组接受前外侧入路,B组接受常规入路.对比两组手术效果、手术指标、手术前后美国矫形足踝协会评分系统(AOFAS)踝-足评分量表评分、应激指标[P物质(SP)、白细胞介素-6(IL-6)、前列腺素E2(PGE2)、降钙素原(PCT)]水平、并发症发生率.结果 A组手术优良率97.44％(38/39),较B组79.49％(31/39)高(P＜0.05);术后1个月、3个月A组AOFAS评分较B组高(P＜0.05);A组骨折愈合耗时较B组短,术中失血量较B组少(P＜0.05);术后1 d、3 d A组血清SP、IL-6、PGE2、PCT 水平较 B 组低(P＜0.05);A 组并发症发生率 2.56％(1/39),较 B 组 20.51％(8/39)低(P＜0.05).结论 与常规入路MIPPO治疗远端OTFF患者相比,应用前外侧入路MIPPO治疗于优化手术指标、减少并发症、提升手术效果、改善踝关节功能方面更具优势,且对机体产生应激影响更小.
Abstract
Objective To compare the results of minimally invasive percutaneous internal fixation(MIPPO)with different approaches in the treatment of patients with distal tibiofibular fractures(OTFF).Methods The 78 patients with distal OTFF in our hospital(January 2020 to October 2022)were selected and divided into group A(n=39)and group B(n=39)according to the random number table method.2 groups were treated with MIPPO,with group A receiving the anterolateral approach and group B receiving the conventional approach.The surgical results,surgical indexes,pre-and post-operative American Orthopaedic Foot and Ankle Society Scoring System(AOFAS)ankle-foot rating scale scores,stress indexes[substance P(SP),interleukin-6(IL-6),prostaglandin E2(PGE2),calcitoninogen(PCT)]levels,and complication rates were compared between 2 groups.Results The excellent surgical rate was higher in group A(97.44％)(38/39)than in group B(79.49％)(31/39)(P＜0.05);the AOFAS score was higher in group A than in group B at 1 month and 3 months after surgery(P＜0.05);fracture healing took less time in group A than in group B,and intraoperative blood loss was lower than in group A(P＜0.05).Serum SP,IL-6,PGE2,and PCT levels were lower in group A compared with group B at 1d and 3d postoperatively(P＜0.05);the complication rate was lower in group A(2.56％(1/39)compared with group B(20.51％(8/39))(P＜0.05).Conclusion Compared with the conventional approach to MIPPO for distal OTFF patients,the anterolateral approach to MIPPO is more advantageous in optimizing surgical indexes,reducing complications,improving surgical outcomes,and improving ankle function with less stressful effects on the organism.
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