经皮微创钢板内固定与切开复位内固定治疗不同分型胫骨远端骨折疗[摘要]目的：探讨经皮微创钢板内固定与切开复位内固定治疗不同分型胫骨远端骨折疗效及指征。方法：回顾性分析我院2006年10月~2010年6月收治的胫骨远端骨折未累及关节面患者80例，将采用闭合复位经皮微创钢板内固定患者36例作为研究组，将采用切开复位内固定患者44例作为对照组，比较两组患者骨折愈合时间、畸形愈合及并发症发生率。结果：研究组手术时间及术中出血量均少于对照组，差异均有统计学意义（均P<0.05）。全部患者术后平均随访12.5个月，两组A1、A2、B1、B2、B3型骨折愈合时间差异无统计学意义（P>0.05），研究组A3型骨折愈合时间长于对照组，C1、C2、C3型骨折愈合时间短于对照组，差异均有统计学意义（均P<0.05）。两组骨不连和畸形愈合发生率比较，差异有统计意义（P<0.05），两组延迟愈合及切口感染发生率比较，差异无统计学意义（均P>0.05）。结论：经皮微创钢板内固定术治疗C型胫骨远端骨折效果较好，在对B型及A1、A2型胫骨远端骨折的治疗中疗效较切开复位内固定术无明显优势，并且其对A3型胫骨远端骨折的治疗效果差于切开复位内固定术。[关键词]胫骨远端骨折；经皮微创钢板内固定；切开复位内固定[]R683.423[文献标识码]Ａ[]1673-7210（2011）12（a）-048-03ClinicalcurativeeffectandindicationsofminimallyinvasivepercutaneousplatefixationandopenreductionandinternalfixationinthetreatmentofdifferenttypesofdistaltibialfracturesCHANGGuorong,CENZhicong,GAOHonghui,GAO激an激anDepartmentofOrthopedics,ShilingHospitalofHuaduDistrictinGuangzhouCity,GuangdongProvince,Guangzhou510850,China[Abstract]Objective:Todiscusstheefficacyandindicationsofminimallyinvasivepercutaneousplatefixation(MIPPO)andopenreductionandinternalfixationinthetreatmentofdifferenttypesofdistaltibialfractures.Methods:80casesofpatientswhowerediagnosedwithdistaltibialfracturesandnoarticularsurfaceinvolvedinourhospitalfromOctober2006toJune2010wereanalyzedretrospectively.MIPPOtreatmentof36casesofpatientsweredividedintostudygroup,andopenreductionandinternalfixationtreatmentof44casesofpatientsweredividedintocontrolgroup.Fracturehealingtime,malunion,complicationincidenceofthetwogroupswerecompared.Results:Amountofbleedinglossandoperativetimeofstudygroupwerelessthanthoseofthecontrolgroup,thedifferenceswerestatisticallysignificant(P<0.05).Allpatientswerefollowedupforaverageof12.5months,healingtimeofA1,A2,B1,B2,B3typefractureoftwogroupshadnosignificantdifference(P>0.05),thehealingtimeofA3typesfractureofstudygroupwaslongerthanthatofthecontrolgroup,andthehealingtimeofC1,C2,C3typesfracturewereshorterthanthoseofthecontrolgroup,thedifferenceswerestatisticallysignificant(P<0.05).Nonunionandmalunionincidenceofthetwogroupsweresignificantlydifferent(P<0.05),delayedhealingandwoundinfectionrateofthetwogroupshadnosignificantdifference(P>0.05).Conclusion:CurativeefficacyofMIPPOinthetreatmentofCtypeofdistaltibialfracturesisbetterthanopenreductionandinternalfixation,butinthetreatmentofB,A1,A2typeofdistaltibialfracture,thecurativeefficacyofthetwomethodshavenosignificantlydifferent,andcurativeefficacyofMIPPOinthetreatmentofA3typeofdistaltibialfractureisworsethanopenreduction.[Keywords]Distaltibialfractures;Minimallyinvasivepercutaneousplatefixation;Openreductionandinternalfixation近年来随着微创技术的发展及骨折固定器械、技术的革新，经皮微创钢板内固定（minimallyinvasivepercutaneousplatefixation，MIPPO）在四肢骨折治疗中得到了广泛应用，其可最大限度地保留骨折处血供，促进骨折愈合，减少感染和骨不连的风险。已有文献报道称，MIPPO可以减少骨膜损伤、缩短骨折愈合时间[1-2...