经皮微创钢板固定技术治疗累及骨干的胫骨平台骨折

Minimally invasive percutaneous plates osteosynthesis for fracture of tibial plateau involving the tibial shaft

目的探讨经皮微创钢板固定技术(MIPPO)治疗累及骨干的胫骨平台骨折的方法和临床效果。方法选择采用MIPPO技术治疗累及骨干的胫骨平台骨折患者18例。手术时间为伤后1～14 d。术后早期进行功能锻炼,视骨折愈合情况决定负重时间。术后即刻、6、12周、6个月及末次随访时常规拍X线片了解骨折愈合情况,并记录患者完全负重行走时间;观察术后及随访过程中有无并发症发生。结果患者切口均Ⅰ期愈合,无皮瓣坏死及切口感染,1例术后10个月胫骨远端切口内侧出现红肿破溃,并有脓性物出现,考虑为内固定手术造成的迟发型低毒感染,去除内固定并行局部清创后痊愈。完全负重行走平均时间为(15.5±2.3)周;X线片愈合平均时间为(13.8±3.5)周;无延迟愈合及骨不连等并发症发生。美国特种外科医院膝关节评分显示优12例,良5例,中1例,差0例;Johner-Wruhs评分结果显示优10例,良7例,中1例,差0例。18例患者术后总优良率为94.4%。结论 MIPPO创伤小,固定可靠,组织感染率低,并发症少,骨愈合率高,是治疗累及骨干的胫骨平台骨折安全有效的方法。

Objective To explore the methods and the clinical results of minimally invasive percutaneous plates osteosynthesis（MIPPO）in treatment on fracture of tibial plateau involving the tibial shaft.Methods Eighteen cases with fracture of tibial plateau involving the tibial shaft were selected and treated by MIPPO.The operations were conducted in 1-14 days after hurt.The early functional exercise was carried out after operation.Loading time depended on the fracture healing condition.X ray films were taken in the immediate,6,12 weeks,6 months after operation and the final follow-up to assess the fracture healing and record the full weight bearing time.The complications were observed after operation and follow-up process.Results The incision healed at the primary stage.There were no skin flap necrosis and incision infection.One patient occurred red burst and purulent complications in distal tibia incision inside at 10 months after operation.This complication was considered as a late onset low infection which related with the internal fixed surgery.The fracture was healing well,and recovered after removing the fixed.The mean time for full weight bearing was（15.5±2.3）weeks;the mean healing time of X-ray was（13.8±3.5）weeks.There were no delayed union and nonunion.According to the hospital for sepcal surgery knee score,there were 12 excellent,5 good,1 fair and no poor;according to the Johner-Wruhs score,there were 10 excellent,7 good,1 fair and no poor.The excellent and good rate after operation of the 18 patients was 94.4%.Conclusion MIPPO is a safe and effective treatment for fracture of tibial plateau involving the tibial shaft with smaller wound and more reliable fixation,lower tissue infection and higher union rate.