经皮微创锁定加压钢板内固定治疗胫骨骨折

MINIMALLY INVASIVE PERCUTANEOUS LOCKING COMPRESSION PLATE INTERNAL FIXATION IN THE TREATMENT OF TIBIAL FRACTURES

目的总结经皮微创锁定加压钢板(locking compressionplate,LCP)内固定术治疗胫骨骨折的方法和临床疗效。方法2005年9月-2007年9月,采用间接复位经皮微创LCP内固定技术治疗胫骨骨折13例。男8例,女5例;年龄18～35岁,平均27岁。致伤原因:车祸伤3例,摔伤5例,高处坠落伤4例,砸伤1例。骨折部位:胫骨上1/3骨折2例,中1/3骨折6例,下1/3骨折5例。均为闭合骨折。骨折按AO分型:A型4例,B型7例,C型2例。伤后至手术时间3h～5d,平均2.5d。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间10～18个月,平均13个月。术后骨折均达临床愈合,愈合时间为12～20周,平均16周。无内固定失败及松动,无旋转及短缩畸形等并发症发生。患肢膝关节功能按HSS评分为85～95分,平均90分;关节活动度为100～130°,平均120°;患肢踝关节功能按美国足踝外科学会制定的踝与后足功能评分标准评分为80～95分,平均92.4分;优9例,良4例,优良率100%。结论经皮微创LCP内固定治疗胫骨骨折符合生物学固定原则,有利于胫骨骨折的愈合及骨折端软组织的修复。

Objective To summarize the clinical application of minimally invasive percutaneous locking compression plate （LCP） internal fixation in the treatment oftibial fractures and to evaluate its clinical effects. Methods From September 2005 to September 2007, 13 patients with tibial fractures were treated with indirect reduction and minimally invasive percutaneous LCP internal fixation, 8 males and 5 females, aged 18-35 years old （27 on average）. Among them, the fractures were caused by traffic accidents in 3 cases, by falling in 5 cases, by falling from height in 4 cases and by bruise in 1 case. The fractures were located at 1/3 upper tibia in 2 cases, at 1/3 medium tibia in 6 cases and at 1/3 lower tibia in 5 cases. All fracture were closed ones. According to the AO classification, 4 cases were type A, 7 type B and 2 type C. The time between fractures and operation was from 3 hours to 5 days （2.5 days on average）. Results All incisions obtained healing by first intention. All patients were followed up for 10-18 months （13 months on average）. All fractures reached clinical healing, and the healing time was 12-20 weeks （16 weeks on average）. There was no delayed fracture healing, nonunion, infection and internal fixation failure. No complications such as rotation, crispatura deformity and internal fixation loosening were found. According to the HSS scoring, the function of the knee joint was graded 85-95 （90 on average）, and the range of motion was 100-130^o （120^o on average）. According to the AOFAS Ankie Hindfoot Scoring, the function of the ankle joint was graded 80-95 （92.4 on average）. Nine cases were excellent, 4 good, and the choiceness rate was 100%. Conclusion Minimally invasive percutaneous LCP internal fixation is in accord with biological set princi pies and beneficial for tibial fracture healing and reconstruction of soft tissues.