MIPPO技术在胫骨干远端闭合性骨折急诊手术中的应用价值

Application value of MIPPO technology in emergency surgery for closed distal tibial shaft fractures

摘要:

目的 观察微创经皮钢板内固定（MIPPO）技术在胫骨干远端闭合性骨折（AOOTA）患者急诊手术中的应用效果。方法 该研究为前瞻性研究，经整体抽样法选择河南科技大学第二附属医院2020年1月至2023年1月期间收治的105例AOOTA患者为研究对象，基于数字表法将其分为常规组（52例）和MIPPO组（53例），常规组实施急诊切开复位内固定治疗，MIPPO组实施急诊MIPPO手术治疗，治疗后均开展为期半年随访，比较两组患者的治疗、康复情况，手术应激情况，胫骨关节结构、功能改善情况及术后并发症发生情况。结果 在不同治疗方案下，MIPPO组的术中透视时间、术中出血量、手术耗时、住院时间、骨折线消失时间分别为（13.36±3.27）min、（75.45±10.27）mL、（70.33±10.42）min、（10.24±2.25）d、（10.35±2.33）周，均低于常规组［（15.77±3.42）min、（80.44±10.38）mL、（75.45±10.26）min、（14.49±4.36）d、（12.77±3.41）周］（P<0.05）；MIPPO组的血清P物质（SP）、前列腺素E2（PGE2）分别为（90.41±10.24）pg/mL、（145.33±20.62）pg/mL，低于常规组［（95.88±10.27）pg/mL、（160.33±20.72）pg/mL］，超氧化物歧化酶（SOD）［（120.75±20.42）U/mL］高于常规组［（105.44±20.36）U/mL］（P<0.05）；MIPPO组的胫骨角、胫骨内侧平台后倾角、外侧平台后倾角分别为（95.22±10.36）°、（15.34±3.72）°、（13.36±3.25）°，均高于常规组［（90.27±10.26）°、（13.41±3.15）°、（11.45±3.36）°］（P<0.05）；MIPPO组术后3个月、6个月的膝关节Lysholm量表评分分别为（75.25±10.36）分、（84.39±10.29）分，均高于常规组［（70.33±10.62）分、（79.35±10.25）分］，膝关节疾病严重程度（HSS）评分分别为（76.62±10.31）分、（85.61±10.23）分，均高于常规组［（71.44±10.21）分、（80.33±10.49）分］（P<0.05）；MIPPO组的术后并发症发生率［9.43%（5/53）］低于常规组［23.08%（12/52）］（P<0.05）。结论 MIPPO技术能有效改善患者的治疗效果并加快康复情况，对减轻手术应激、促进患者胫骨结构和功能恢复并降低并发症发生风险均有积极意义。

Abstract:

Objective To observe the application effect of minimally invasive percutaneous plate osteosynthesis (MIPPO) technology in emergency surgery for AOOTA patients.Methods This study is a prospective study. A total of 105 AOOTA patients admitted to Second Affiliated Hospital of Henan University of Science and Technology between January 2020 and January 2023 were selected as the study subjects through a holistic sampling method. They were divided into a conventional group (52 cases) and a MIPPO group (53 cases) based on the digital table method. The conventional group received emergency open reduction and internal fixation treatment, while the MIPPO group received emergency MIPPO surgery. After treatment, both groups underwent a six-month follow-up to compare their treatment, rehabilitation, and surgical stress levels, the improvement of tibial joint structure and function, as well as the occurrence of postoperative complications.Results Under different treatment regimens, the intraoperative fluoroscopy time, intraoperative bleeding volume, surgical time, hospitalization time, and fracture line disappearance time of the MIPPO group were 13.36±3.27 minutes, 75.45±10.27 mL, 70.33±10.42 minutes, 10.24±2.25 days, and 10.35±2.33 weeks, lower than the conventional group (15.77±3.42 minutes, 80.44±10.38 mL, 75.45±10.26 minutes, 14.49±4.36 days, and 12.77±3.41 weeks) (P<0.05). The SP and PGE2 levels in the MIPPO group were 90.41±10.24 pg/mL and 145.33±20.62 pg/mL, lower than the conventional group (95.88±10.27 pg/mL and 160.33±20.72 pg/mL), and the SOD in the MIPPO group (120.75±20.42 U/mL) was higher than the conventional group (105.44±20.36 U/mL) (P<0.05). The tibial angle, medial tibial plateau posterior angle, and lateral plateau posterior angle of the MIPPO group were 95.22°±10.36°, 15.34°±3.72°, and 13.36°±3.25°, higher than the conventional group (90.27°±10.26°, 13.41°±3.15°, and 11.45°±3.36°) (P<0.05). The Lysholm scores of the knee joint in the MIPPO group at 3 and 6 months after surgery were 75.25±10.36 points and 84.39±10.29 points, higher than the conventional group (70.33±10.62 points and 79.35±10.25 points) (P<0.05). The HSS scores were 76.62±10.31 points and 85.61±10.23 points, higher than the conventional group (71.44±10.21 points and 80.33±10.49 points) (P<0.05). The incidence of postoperative complications in the MIPPO group was 9.43% (5/53), lower than the conventional group [23.08% (12/52)] (P<0.05).Conclusion MIPPO technology can effectively improve the treatment effect of patients and accelerate their recovery, reduce surgical stress, promote the recovery of tibial structure and function, and reduce the risk of complications.