经皮微创钢板固定技术治疗胫骨近端粉碎骨折

Treatment of proximal tibia comminute fractures using minimally invasive percutaneous plating osteosynthesis technique

目的总结应用MIPPO技术治疗胫骨近端粉碎骨折的临床经验及治疗效果。方法应用MIPPO技术治疗的12例高能量胫骨近端骨折患者，其中3例合并其它骨折，5例为开放性骨折（Gusfilo ⅢA3例，ⅢB2例）。术中一般取膝前外侧切口，在手力牵引或外固定支架辅助下进行平台及干骺端骨折的复位及临时固定；如有骨缺损或塌陷，则植骨填充。将LISS钢板沿胫骨前外侧面经肌下置入前筋膜室，C型臂机透视确认钢板的位置准确后，在导向装置的引导下拧入锁定螺钉固定，远端螺钉可以经皮置入。结果平均随访15个月（12～36个月）。12例获得完全骨性愈合；患者完全负重时间14．2周（12～18周），X线愈合时间15．5周（11～17周）。2例术后6个月随访出现关节面复位丢失，无固定失效及力线不正；关节活动度平均为4°（0°－15°）～100．6°（60°～120°）。术后6个月功能优7例、良4例、中1例、差0例，优良率为91．7％。结论MIPPO技术治疗胫骨近端粉碎骨折．有较好的力学稳定性，骨折愈合率高，软组织损伤小，并发症发生率低，是一种有效的治疗手段。

Objective To summarize clinical experiences and therapeutic effects of minimally invasive percutaneous plating osteusynthesis （MIPPO） technique applied in treatment of proximal tibia fractures. Methods 12 patients with high-energy proximal tibia eomminute fractures were treated with MIPPO. According to AO classification, 4 case were type 41 -A, 2 case were type 41-B ,6 case were type 41 -C （ 3 combined with other fractures ,5 were opened fractures）. The surgical exposures were usually from posterior-lateral. Fractures were reduced and temporarily fixed with an external fixator, and bone graft was performed in ease of bone defect. A LISS plate was deposited pereutaneously in the posterior compartment of the anadesma guided with C-arm perspective. Results All cases were followed up for an average time of 15 months （ ranging 12 to 36 months） ,all fractures were eventually healed, the mean time of full weight bearing was 14. 2 weeks （ ranging from 12 to 18 weeks ） ,and the mean time of radiographic healing was 15.5 weeks （ ranging from 11 to 17 weeks ）. 2 cases were showed with displacement of articular surface 6 months after operation. No internal fixation failure and disalignment occurred. The range of motion was 4° to 100. 6°. By Johner-Wruhs＇evaluation,7 cases were rated as excellent, 4 good, 1 fair one year after operation. Conclusions MIPPO is a safe method for proximal tibia eomminute fractures,the benefits include better mechanical stability,less intervention of blood supply, less soft tissue complications and a high union ratio of fractures.