MIPPO技术下前后联合入路治疗复杂胫骨平台骨折的疗效

Clinical Efficacy of Anterior-posterior Approach Combined with MIPPO Technique for the Treatment of Complex Tibial Plateau Fracture

[目的]探讨在三柱理论的指导下行微创经皮钢板内固定（MIPPO）技术结合前后联合入路治疗复杂胫骨平台骨折的临床疗效。[方法]20例复杂胫骨平台骨折患者术前均．经CT扫描及三维重建。全部采用后路和前外路、后路和前内侧联合入路，后路小钢板和前侧锁定钢板联合固定，同时植骨。[结果]术后X线片检查示达到解剖复位12例，功能复位8例。1例切口皮缘坏死。经清创后愈合。20例均获12个月以上的随访。骨折全部愈合，愈合时间6．5～9个月，平均7．8个月。优8例，良7例，可3例，差2例，优良率为75％。[结论]胫骨平台骨折三柱分型可帮助医生选择最佳的手术入路和内固定方式，MIPPO技术结合前后联合入路能够有效预防术后伤口感染和骨不连等并发症，是治疗复杂胫骨平台的有效方法。

[Objective] To explore the clinical efficacy of MIPPO technique combined with anterior-posteri- or approach guided by three-column theory for the treatment of complex tibial plateau fracture. [Methods] CT scan and three-dimensional reconstruction was performed for 20 patients with complex tibial plateau fracture before the operation. All patients underwent the posterior, anterior lateral, posterior and anterior combination approach, posterior small steel plate and anterior-lateral locking plate joint fixation and bone graft. [Results] After the operation, X-ray examination revealed that 12 cases reached anatomical reduction and 7 cases had functional reduction. One patient with the necrosis of incision margin was healed after debridement. All the 20 patients were followed up for more than 12 months. The fractures were all healed. The healing time was 6.5- 9 months with the average of 7.8 months. Among all patients, 8 patients were excellent, and 7 patients were good, and 3 patients were fair, and 2 patients were poor. The excellent and good rate was 75%. [Conclusion] Three-column typing of tibial plateau fracture can help the physicians choose the best surgical approach and internal fixation method. MIPPO technique combined with anterior-posterior approach can effectively prevent the incidence of the complications such as wound infection and bone nonunion, and is an effective method for the treatment of complex tibial plateau fracture.. [-