经皮微创锁定加压钢板置入内固定治疗新鲜胫骨远端骨折32例

Locking compression plate withminimally invasion percuteoneous plate osteosynthesis for 32 patients with diaphyseal and distal tibial fracture

背景:传统钢板置入内固定治疗胫骨远端骨折过程中为保证骨折解剖复位,需广泛剥离骨膜直接暴露骨折端,常造成伤口愈合不良、感染和骨延迟愈合等不良后果。目的:观察经皮微创锁定加压钢板置入内固定治疗胫骨远端骨折的效果。方法:选择新鲜胫骨远端骨折患者32例,男26例,女6例,年龄18～76岁,均采取闭合复位,小切口手术入路置入胫骨远端锁定加压钢板置入内固定治疗。置入后随访行X射线检查,采用Johner-Wruhs评分评估治疗效果。结果与结论:30例平均随访16个月,骨折均获愈合,临床平均愈合时间14周;其中外踝手术切口浅表感染2例,皮肤刺激症状4例,螺钉断裂1例(术前X射线片无法诊断断裂),钢板远端断裂1例,腓浅神经损伤1例。按Johner-Wruhs评分法,功能优22例,良6例,中2例,优良率为93%。说明经皮微创锁定加压钢板置入内固定治疗胫骨远端骨折创伤小、不良反应少、固定牢固、骨折愈合率高、符合生物学固定原则。

BACKGROUND： To ensure anatomical reduction, traditional plate internal fixation strips extensive periosteum to expose the fracture during treatment of distal tibial fracture, resulting in adverse effects, such as infection, wound, infection and delayed bone healing. OBJECTIVE： To evaluate the clinical effects of locking compression plate with minimally invasion percutaneous plate osteosynthesis on diaphyseal and distal tibial fracture. METHODS： A total of 32 patients with diaphyseal and distal tibial fracture were selected, including 26 males and 6 females, aged 18-76 years. They were treated with locking compression plate with minimally invasion percuteoneous plate osteosynthesis through closed reduction and minimal incision approach. After the operation, the patients were followed-up and examined by X-ray. The treatment effects were evaluated using Johner-Wruhs score assessment. RESULTS AND CONCLUSION： The 30 patients were followed up for 16 months. The fracture was healed, for an average healing time of 14 weeks. Two patients developed incision infection, 4 presented skin stimulation symptoms, 1 had screw breakage （Breakage was not detected by preoperative X-ray）, 1 plate breakage, and 1 had superficial peroneal nerve injury. Johner-Wruhs score was excellent in 22 cases, good in 6, and fair in 2. The total excellent to good rate was 93%. Results show that locking compression plate with minimally invasion percuteoneous plate osteosynthesis in treatment of diaphyseal and distal tibial fracture leads to limited invasion, reliable fixation, low rate of complication, high rate of union, and well matches biological fixation principles.