微创技术植入锁定加压钢板治疗胫骨远端骨折

APPLICATION OF MINIMALLY INVASIVE LOCKING COMPRESSION PLATE IN TREATMENT OF DISTAL TIBIA FRACTURES

目的探讨采用微创接骨板固定(minimally invasive plate osteosynthesis,MIPO)技术植入锁定加压钢板(locking compression plate,LCP)治疗胫骨远端骨折的临床效果。方法2002年8月-2007年8月,采用MIPO技术植入LCP治疗62例胫骨远端骨折患者。其中男36例,女26例;年龄21～87岁,平均44岁。均为胫骨远端新鲜骨折。骨折根据AO分型,A1型8例,A2型15例,A3型9例,B3型7例,C1型11例,C2型12例。开放骨折10例,GradeⅠ型6例,Ⅱ型4例;闭合骨折52例。创伤指数为4～24,平均12.6。受伤至手术时间8h～6d。术后3个月每月复查X线片,术后6、12个月定期随访,骨折牢固愈合、拆除钢板后再随访6个月。结果术中56例获接近解剖复位,6例仅达可接受复位。手术时间37～120min,平均43min。术后切口均Ⅰ期愈合。62例均获随访,随访时间18～45个月,平均23个月。X线片示骨折均达骨性愈合,愈合时间16～32周,平均19.5周。41例于术后15～24个月拆除钢板,平均16个月。术后12个月按Teeny等踝关节功能评分标准评价,获优30例,良25例,可7例,优良率88.7%。7例发生延迟软组织感染,拆除内固定后功能恢复良好;1例发生小腿骨筋膜室综合征,行筋膜室切开减压;1例术后6个月胫骨远端腓侧关节面发生塌陷,拆除内固定并植骨后愈合良好。结论采用MIPO技术植入LCP治疗胫骨远端骨折可获满意效果,无严重并发症发生。

Objective To evaluates the application of minimally invasive plate osteosynthesis （MIPO） technique in treatment of distal tibia fractures with locking compression plate （LCP）. Methods From August 2002 to August 2007, 62 subjects were recruited （36 males and 26 females） at mean age of 44 years old （range, 21-87 years old）. According to AO classification, there were 8 cases of type A1, 15 cases of type A2, 9 cases of type A3, 7 cases of type B3, 11 cases of type C1, and 12 cases of type C2. Of them, 52 patients had closed fractures and 10 had open fractures. Ten open fractures included 6 Grade I fracture and 4 Grade II fracture. The time from injury to operation was 8 hours to 6 days. The X-ray films were taken after 3 months of operation. Results Near anatomical reduction was achieved in 56 fractures and acceptable reduction in 6 fractures. Mean operation time was 43 minutes （range, 37-120 minutes）. Primary healing of surgical wounds was observed in all cases. Subjects were followed up for 23 months on average （ranged, 18-45 months）. All fractures healed with a mean healing time of 19.5 weeks （range, 16-32 weeks）. According to Teeny and Wiss ankle scoring system, 30 patients got excellent results, 25 good, and 7 fair; and the excellent and good rate was 88.7% at 12-month follow-up. There were 7 cases of delayed soft tissue infection which needed implant removal. There was one complication of compartment syndrome which required fasciotomy. There was one case with loss of reduction （valgus tilting of tibial plafond） that required bone grafting. Conclusion The results of MIPO LCP in treatment of distal tibia fractures were satisfactory. This technique was safe with no incidence of serious complications.