应用锁定加压钢板治疗胫骨中下1/3骨折

Locking compression plate with minimally invasive plate osteosynthesis in distal tibial fracture of metaphysis

目的 回顾总结应用微创钢板骨固定术(minimally invasive plate osteosynthesis,MIPO)以锁定加压钢板(locking compression plate,LCP)治疗胫骨中下1/3骨折的经验.方法 2005年10月至2007年6月,应用MIPO技术以LCP桥式固定方式治疗胫骨中下1/3骨折患者36例.男26例,女10例,平均年龄43.8岁(20～64岁).A1型2例,A2型11例,A3型23例.伤后至手术时间平均7.1 d(5～23d).23例行胫骨骨折端闭合复位,13例行胫骨骨折端有限切开辅助复位.复位后再以MIPO技术置入LCP并桥式固定.24例患者行腓骨骨折的切开复位内固定术.于术后1、2、3、6个月复查,分别进行临床查体、X线片评估及康复指导.骨折愈合后对患者踝关节功能以lowa评分系统评分.结果 平均手术时间93.4 min(60～160 min).平均失血量78 ml(50～200 ml).骨折端至少旷置3个钉孔,螺钉密度平均为0.65(0.50～0.73),平均置入螺钉9.6枚(7～14枚),LCP平均长度为225ram(165.5～243.5 mm).平均随访14.7个月(6～26个月).平均愈合时间4.2个月(2.5～6个月).所有患者的LCP及螺钉均无松动、断裂.骨折愈合后小腿全长X线片显示下肢力线无成角及旋转,下肢长度无短缩,膝、踝关节面无倾斜.lowa踝关节评分平均91.6分.优25例,良10例,中l例,优良率97.2%.结论 应用MIPO技术以LCP桥式固定治疗胫骨中下1/3骨折是一种有效保持骨折端血运,符合弹性固定理念并能促进骨折愈合的新技术.

Objective To retrospectively evaluate the distal tibial fracture of metaphysis treated with locking compression plate(LCP)and minimally invasive plate osteosynthesis(MIPO).Methods 36 patients with distal tibial fracture of metaphysic were treated with LCP and MIP0 in our department during October 2005 to June 2007.including 26 males and 10 females.with the mean age waa 43.8 years(20-64 years).According the AO classification system,there were type A1 in 2 cages.A2 in 11 cases and A3 in 23 c88es.The mean duration between the injury and operation was 7.1 d(5-23 d).23 cases performed close reduction,and 13 cages did limited open reduction.then fixed the fracture with LCP using MIPO techniques and bridging plate technique.Interviews were taken in 1st,2nd.3nt and 6th month after operation.and the physical examination,X-ray evaluation.rehabilitation instruction were performed.The evaluation of ankle function was taken with Iowa score system after fracture healing.Results The mean operation time w88 93.4 min(60-160 min).The mean blood lose was 78 ml (50-200 ml).There were at least 3 holes between across the fracture site.The mean density of screws was 0.65(0.50-0.73).The mean number of screws was 9.6(7-14).The mean length of the LCP was 225 mm(165.5-243.5 mm).The all 36 patients were completed follow-up with mean time of 14.7 months(6-26 months).The mean heal time was 4.2 months(2.5-6 months).No loosen and breakage were found in the LCP and screws.In the X-rays of the tibial after bone healing,no malaligment,rotation,shortness.ankle articular slope(including the fibula)were found.The mean score was 91.6(79-98).25 were rated as excellent.10 as good and 1 as fair,the excellent and good rate was 97.2%.Conelusion LCP with MIPO in distal tibial fracture of metaphysis is an effective technique of protecting blood supply of fracture.according with elastic fixation theory and accellerating healing process of fracture.