The Clinical Comparative Study Of Minimal Invasive Percutaneous Plate Fixation With The Limited Incision Plate Fixation Of Distal Tibial Shaft Simple Fractures

Objective Compared with percutaneous closed reduction and the limited incision plate fixation of distal tibial shaft simple fractures,to expound the relationship between the protection of local blood supply, the fixation strength and the reduction quality,so as to provide reference for clinical treatment, so as to obtain better clinical results.Methods Through the retrospective analysis of 80 followed up patients with distal tibial shaft simple fractures in the second hospital of Tangshan from 2010.9 to 2013.9, it divided into two group by surgical: percutaneous group(50) and the limited incision group(30).Observing two groups of operation time, intraoperative blood loss, X-ray perspective times, reduction quality(quality of surgical reduction),length of stay, healing time, postoperative complications, ankle joint function(Using Johner-Wruhs evaluation criteria),to evaluate the clinical effects of percutaneous closed reduction and the limited incision plate fixation for the treatment of distal tibial shaft simple fractures.Result Percutaneous group: operation time is(63.20±8.07)min, intraoperative blood loss is(20.80±5.38)ml, X-ray perspective times is(5.86±1.26), coronal plane angel is(0.82±1.22)°,sagittal plane angel is(3.43±1.46)°,length of stay is(16.50±1.59)d,healing time is(18.90±2.31)w,there are 8 cases who have postoperative complications,3 of superficial wound skin infection, 3 of hematoma, 1 of delayed healing, 1 of non healing;Limited incision group: operation time is(60.27±7.38)min, intraoperative blood loss is(23.17±6.91)ml, X-ray perspective times is(2.90±0.89), coronal plane angel is(1.95±2.86)°,sagittal plane angel is(5.58±1.81)°,length of stay is(16.07±1.60)d,healing time is(16.80±2.54)w, postoperative complications are 4 cases, including 2 cases of superficial wound skin infection, 2 cases of hematoma. Evaluating the limb function after surgery by Johner-Wruhs evaluation criteria,the former group are excellent in 27 cases,good in 13 cases, fair in 8 cases and poor in 2 cases, the excellent and good rate is80.00%; the latter group are excellent in 23 cases, good in 6 cases, fair in 1 case and poor in 0 case, the excellent and good rate is 96.67%. Through statistical analysis, the two groups in operation time, X-ray perspective times,the quality of surgical reduction,healing time, postoperative excellent and good rate difference is statistically significant(P<0.05), the limited incision group is better than the percutaneous group.The difference in intraoperative blood loss, length of stay and postoperative complications has no statistical significance(P>0.05).Conclusion 1 To fully understand the relationship between the protection of local blood supply, the fixed way, the quality of reduction of three, is the key to the treatment of distal tibial shaft simple fractures;2 Under the premise of fully protecting the local blood supply, the quality of the reduction of the distal tibial shaft simple fracture healing plays a key role.3 The technique of limited open reduction is the first choice for the distal tibial shaft simple fractures.