微创经皮钢板内固定治疗胫骨骨折

Minimally Invasive Percutaneous Plate Osteosynthesis for the Treatment of Tibial Fractures: Report of 26 Cases

目的 探讨微创经皮钢板内固定(minimally invasive percutaneous plate osteosynthesis,MIPPO)技术在胫骨骨折治疗中的临床疗效. 方法 我院2005年8月～2007年1月对26例胫骨骨折采用MIPPO技术治疗.其中胫骨近端骨折8例,远端骨折7例,骨干骨折11例. 结果 手术切口长4.0～8.5 cm,平均6.6 cm;术中出血量80～400 ml,平均180 ml;手术时间40～120 min,平均87 min;术后肿胀消退时间1～6 d,平均2.5 d;伤口均一期愈合.26例随访3～15个月,平均6个月,骨折愈合时间3～13个月,平均4.2月.无切口延迟愈合或感染,无软组织坏死及骨外露,无骨折延迟愈合以及不愈合等并发症.膝踝关节功能以Johner-Wruhs方法评价,优19例,良4例,中2例,差1例. 结论 MIPPO技术治疗胫骨骨折软组织损伤轻,创伤反应小,术后恢复快,并发症少,符合生物学要求,是一种值得推广的新型钢板内固定技术.

Objective To evaluate the efficacy of minimally invasive percutaneous plate osteosynthesis(MIPPO) for the treatment of tibial fracture. Methods From August 2005 to January 2007,a total of 26 patients with tibial fracture were treated with MIPPO in our hospital.Among the patients,the facture was located at the proximal tibia in 8,the distal tibia in 7,and the shaft in 11.Results The incision size was 4.0-8.5 cm with a mean of 6.6 cm;the intraoperative blood loss ranged from 80 to 400 ml(mean,180 ml);and the operation lasted 40-120 minutes(mean,87 minutes).The swelling subsided 1-6 days after the operation(mean,2.5 days).All the incisions healed primarily.The patients were followed up for 6 month on average(3 to 15 months).The fractures healed in 3-13 months(mean,4.2) after the operation.No complications,including delayed incision healing,incision infection,parenchymal necrosis,bone exposure,delayed union,and non-union,occurred in the series.According to the Johner-Wruhs criteria,the knee and ankle functions were excellent in 19 patients,good in 4,fair in 2,and poor in 1.Conclusions The MIPPO provides biological fixation and results in minimal parenchymal injury in patients with tibial fracture.By using the technique,the patients recover quickly with few complications and mild reaction to the trauma.The method is an optimal approach that is worth being promoted.