急症微创经皮钢板内固定治疗胫腓骨骨折的临床观察

Clinical Observation of Minimally Invasive Percutaneous Plate Osteosynthesis in the Treatment of Tibiofibular Emergent Fractures

目的:探讨急症微创经皮钢板内固定技术(MIPPO)治疗胫腓骨骨折的临床疗效。方法:所有病例均急症手术,采用有限切口开放复位,经皮插入钢板微创治疗胫腓骨骨折87例,按AO/ASIF分类:A型28例,B型30例,C型29例,其中开放性骨折32例(Gustilo分型:Ⅰ型19例,Ⅱ型13例),多段骨折9例,胫腓骨近端骨折27例,中段骨折16例,远端骨折44例。术后不辅以其他外固定,第2天起即开始不负重关节功能锻炼。结果:所有患者术后随访3～18个月,平均10个月,骨折均愈合,未出现钢板螺钉松动断裂、畸形愈合、感染、复位丢失等并发症。临床愈合时间3～7个月,功能评价采用Johner-Wruhs评分标准,优63例,良24例,优良率100%。2例开放性骨折患者术后发生小范围皮肤坏死,经换药后痊愈。结论:MIPPO技术是治疗胫腓骨骨折的有效方法,可最大限度地保护皮肤软组织,减少骨折端血供的破坏,促进骨折的愈合和患肢功能的恢复。

Objective：To investigate the therapeutic effects of Minimally invasive percutaneous plate osteosynthesis（MIPPO） in the treatment tibiofibular emergent fractures.Methods：All the cases were given emergency surgery,using a limited incision open reduction,87 cases with tibiofibular fracture were treated by Minimally invasive percutaneous plate osteosynthesis（MIPPO）,according to AO/ASIF classification,there were 28 cases of type A,30 cases of type B,29 cases of type C.32 cases were open fractures（according to Gustilo classification,there were 19 cases of type Ⅰand 13 cases of type Ⅱ）.9 cases were segmental fractures,27 cases were proximal fractures,16 cases were middle fractures,44 cases were distal fractures.All cases does not contain tibial plateau and pilon fractures.Active and passive motions of the knee and ankle joints were allowed 2 days after operation without weight-bearing.Results：All the patients were followed up for 3 to 18 months.The mean time of joint separation union were 10 months.There was no delayed union,not appear loose plate and screw fracture,malunion,infection,loss of reduction and other complications.The healing time was 3 to 7 months,function evaluation to Johner-Wruhs score were excellent in 63 cases,good in 24 cases,good rate of 100%.2 cases of open fractures in patients with postoperative skin necrosis of the small-scale,cured after wound dressing.Conclusion：MIPPO is safe and effective technique in the treatment of tibiofibular emergent fractures,thus leading to maximize the protection of skin and soft tissue,reducing the blood supply of fracture damage,promote fracture healing and the recovery of limb function.