经皮微创钢板固定治疗2型糖尿病胫骨远端骨折的疗效观察

Minimally Invasive Percutaneous Plate Osteosynthesis for Fractures of Distal Tibia in Type 2 Diabetic Patients

目的总结应用经皮微创钢板固定(minimally invasive percutaneous plate osteosynthesis,MIPPO)技术治疗2型糖尿病患者胫骨远端骨折的临床经验及治疗效果。方法 2007年5月2010年11月,采用MIPPO技术治疗2型糖尿病合并胫骨远端骨折15例。其中男9例,女6例;年龄38～70岁,平均60岁。左侧胫骨远端骨折4例,右侧11例。单发骨折10例,多发骨折5例。根据AO分型:A1型2例,A2型1例,A3型5例,B1型3例,B3型3例,C1型1例。伤后至手术时间为2～14d。结果 15例患者随访时间8～12个月,平均10个月。手术时间平均89min,术中失血量平均285mL。术后1年采用Johner-Wruhs方法评估疗效:优4例,良5例,中3例,差3例;总体满意率80%。X线片示13例患者骨折均获骨性愈合,愈合时间4～8个月,平均6个月,无再发骨折。3例发生泌尿系统感染,1例发生呼吸系统感染,感染率26.7%。结论 MIPPO技术治疗2型糖尿病胫骨近端骨折具有对骨折周围软组织剥离少、符合生物学固定概念、内固定牢靠、切口较小等优点,降低了切开复位内固定术后并发症的发生率。

Objective To summarize the clinical experiences and effects of minimally invasive percutaneous plate osteosynthesis （MIPPO） technique for type 2 diabetic patients with fractures of distal tibia. Methods From May 2007 to November 2010, 15 type 2 diabetic patients with distal tibia fractures including 9 males and 6 females were treated with minimally invasive percutaneous plate osteosynthesis. Their age ranged from 38 to 70 years old averaging at 60. Left distal tibia fracture occurred to 4 cases, and right distal tibia fracture occurred to 11 cases. Ten patients had single fracture, and 5 had multiple fractures. According to An fracture classification, there were two cases of A1, one cases of A2, five cases of A3, three cases of B1 and B3 respectively, and two cases of C1. The time from the occurrence of fracture to operation was ranged from 2 to 14 days. Results The patients were followed up for 8 to 12 months with an average period of ten months. The average operation time was 89 minutes and perioperative blood loss was （285 ＋ 38） mL. Johner-Wruhs method was used to evaluate the efficacy. Four cases were excellent, 5 were good, 3 were fair, and 3 were poor, with an overall satisfaction rate of 80%. Xray showed that 13 patients were healed. The healing time was 4 to 8 months, averaging 6 months, and no further fractures occurred. There were 3 cases of urinary tract infection and 1 case of respiratory infection with an infection rate of 26. 7%. Conclusion Minimally invasive percutaneous plate osteosynthesis technique for fractures of distal tibia in diabetic patients is a safe method with belter mechanical stability, less intervention of blood sunnly, less soft tissue complications and smaller incisions.