摘要目的 探讨下肢骨折轴向牵引器辅助微创接骨板技术(MIPO)治疗复杂胫骨平台骨折的疗效. 方法 回顾性分析2015年6月至2018年4月滨州医学院附属医院创伤骨科采用MIPO技术治疗的31例复杂骨折患者资料.依据治疗方案的不同分为2组:17例患者采用下肢骨折轴向牵引器辅助治疗(牵引器组),男12例,女5例;年龄(50.8±14.7)岁;骨折Schatzker分型:V型8例,Ⅵ型9例.14例患者不使用撑开器而使用手法牵引辅助治疗(手法组),男9例,女5例;年龄(48.9±9.5)岁;骨折Schatzker分型:Ⅴ型6例,Ⅵ型8例.记录并比较两组患者的手术时间、术中出血量、末次随访时膝关节功能Rasmussen评分及胫骨近端内侧角等数据. 结果 牵引器组和手法组患者术前一般资料比较差异均无统计学意义(P＞0.05),具有可比性.牵引器组和手法组患者分别获平均9.8、10.9个月随访.所有患者均获骨性愈合.牵引器组与手法组的手术时间分别为(127.8±40.8)、(174.1±66.8)min,出血量分别为(115.6±41.7)、(184.3±91.4) mL,以上项目两组间比较差异均有统计学意义(P＜0.05).牵引器组患者的膝关节屈曲活动度为126.1°±9.3°、胫骨近端内侧角为87.8°±1.4°、后倾角为8.7°±3.8°、末次随访时膝关节功能Rasmussen评分为(26.5±2.9)分,手法组患者的膝关节屈曲活动度为124.7°±8.9°、胫骨近端内侧角为86.9°±2.1°、后倾角为9.8°±4.1°、末次随访时膝关节功能Rasmussen评分为(25.6±3.2)分,以上项目两组间比较差异均无统计学意义(P＞0.05).末次随访时所有患者骨折部位均未见力线丢失. 结论 与传统手法复位相比,使用下肢骨折轴向牵引器辅助MIPO技术治疗Schatzker Ⅴ、Ⅵ型胫骨平台骨折,能有效缩短手术时间,减少出血量,便于骨折块复位.

abstractsObjective To investigate the clinical efficacy of minimally invasive plate oseoynthesis (MIPO) assisted by a self-designed lower limb axial tractor in the treatment of complex tibial plateau fractures.Methods The data were retrospectively analyzed of the 31 patients who had undergone surgical treatment for complex tibial plateau fractures from June 2015 to April 2018 at Department of Orthopeadics,Hospital Affiliated to Binzhou Medical College.MIPO was conducted with the assistance of the axial tractor in 17 of them.They were 12 men and 5 women with an age of 50.8 ± 14.7 years,with 8 cases of Schatzker type Ⅴ and 9 ones of Schatzker type Ⅵ.MIPO was conducted without the assistance of the axial tractor but with the assistance of manipulation reduction in the other 14 patients.They were 9 men and 5 women with an age of 48.9 ± 9.5 years,with 6 cases of Schatzker type Ⅴ and 8 ones of Schatzker type Ⅵ.The 2 groups were compared in terms of operation time,intraoperative bleeding,and Rasmussen scores for knee function and medial angle of the proximal tibia at the last follow-up.Results The 2 groups were comparable due to insignificant differences in the preoperative general data between them (P ＞ 0.05).The tractor and manipulation groups were followed up for a mean of 9.8 months and 10.9 months respectively.Bone healing was achieved in all patients.For the tractor and manipulation groups,respectively,the operation time was 127.8 ±40.8 min and 174.1 ±66.8 min,and the intraoperative bleeding 115.6 ±41.7 mL and 184.3 ± 91.4 mL,showing significant differences between them (P ＜ 0.05).In the tractor group at the last follow-up,the knee flexion was 126.1°± 9.3°,the medial angle of the proximal tibial 87.8°± 1.4°,the posterior inclination angle 8.7° ± 3.8° and the Rasmussen score 26.5 ± 2.9 points;in the manipulation group at the final follow-up,the knee flexion was 124.7° ± 8.9°,the medial angle of the proximal tibial 86.9° ± 2.1°,the posterior inclination angle 9.8° ±4.1° and the Rasmussen score 25.6 ± 3.2 points.There were no significant differences between the 2 groups in the above items (P ＞ 0.05).Loss of force line was observed in none of the patients at the last follow-up.Conclusion Compared with conventional manipulation reduction,use of our self-designed lower limb axial tractor can shorten operation time,reduce bleeding and facilitate reduction of fracture fragments in the treatment of tibial plateau fractures of Schatzker types Ⅴ and Ⅵ.