分期微创治疗小腿多段骨折

Two-staged and minimally invasive surgical treatment of tibia segmental fractures

目的 探讨胫腓骨多段骨折的分期微创治疗疗效. 方法 对33例伴有多发性创伤的胫腓骨多段骨折采用分期治疗、闭合复位、经皮插入钢板或非扩髓交锁髓内钉微创治疗. 骨折早期先予以外固定支架或跟骨结节牵引暂时固定.7～20 d（平均15 d）待情况稳定后,二期采用微创技术对骨折予以内固定.结果 33例均得到随访, 时间5～36个月,平均9.3个月.所有病例伤口一期愈合,骨折平均临床愈合时间15.1周,根据Johner-Wruhs评分, 优良率88%. 结论 微创手术是胫腓骨多段骨折治疗的有效方法,经皮插入钢板或非扩髓交锁髓内钉是较好选择,具体选用取决于骨折类型、全身状况等.分期治疗可降低手术风险.

Objective To study the effect of two-staged and minimally invasive surgical treatment of tibia segmental fractures. Methods 33 cases of tibia segmental fractures were treated with two-staged and minimally invasive surgical technology. In early stage, fractures were stabilized temporarily by calcaneal traction or external fixations immediately. When the soft tissue and life condition recovered, （after 7 -20 d, average of 15 d） with a minimally invasive surgical method of using close reduction and percutaneous plate osteosynthesis or unreamed tibial nail, the fractures were fixed finally. Active and passive motion of knee and ankle joint was allowed two days after operation without weight-bearing. Results All the patients were followed up for 5 ～ 36 months. The mean time of bone union was 15.1 weeks. According to Johner-Wruhs score, the excellent and good rate was 88%. Conclusions Minimally invasive surgical method is a safe and effective technique in the treatment of tibia segmental fractures. The internal fixation depends on types of fractures and general condition. Two-staged surgical treatment helps to reduce the risk of operation.