土家医正骨手法闭合复位联合MIPPO技术治疗胫骨骨折32例

Clinical Efficacy of Closed Reduction by Bone-setting Manipulation of Tujia medicine Combined with MIPPO Technique in the Treatment of Tibial Fractures

目的：观察土家医正骨手法闭合复位联合MIPPO技术治疗胫骨骨折的临床疗效。方法：回顾性分析2010年01月以来采用土家医正骨手法闭合复位联合MIPPO技术治疗并获随访的32例胫骨骨折的治疗结果。结果：本组32例患者，手术平均失血量64（45～85）mL，手术平均操作时间52（46～60）min，平均住院天数12．8（10～18）d，术后所有X线片示骨折对位对线及钢板螺钉位置良好。术后切口均Ⅰ期愈合，无切口皮肤坏死、浅层或深层感染、骨筋膜室综合征。32例患者均获随访，平均随访时间13．4（10-22）个月，所有骨折都骨性愈合，骨折平均愈合时间为15．6（12～20）周，无医源性神经血管损伤、内固定松动、断钉断板、骨折再移位及延迟愈合等情况发生。术后16周均下地行走，术后28周行走无跛行。根据Johner-Wruhs关节功能评价标准，32例中，优25例，良6例，可1例，差0例，优良率96．875％。结论：土家医正骨手法闭合复位联合MIPP0技术治疗胫骨骨折，结合了民族医学传统正骨手法与现代医学的优点。既达到了良好骨折骨位相对稳定的临床效果，又充分保护了骨折愈合的生物学环境，是治疗胫骨骨折的一种有效、安全可靠的方法，同时也符合微创生物学内固定原理。

t Objective：To observe the clinical efficacy of closed reduction by bone-setting manipulation of Tujia medicine com- bined with MIPPO in the treatment of tibial fracture. Methods：All 32 cases of tibial fracture, which were treatment for the closed reduction by bone-setting manipulation of Tujia medicine combined with MIPPO treatment method, were retrospec- tive analysis since January. Results：The average blood loss and time of operation were 64 （45-85） mL, and 52 （46-60） min respectively, the average days of hospitalization was 12.8 （10-18） d, the postoperative X-ray films showed fracture align- ment and good position of the plate and screws. All the postoperative incisions were healing by first intention. There was no skin incision necrosis, shallow or deep infection, and osteofaseial compartment syndrome. All 32 patients were followed up, the mean follow-up time was 13.4 （10-22） months, they were all bony union, the average fracture healing time was 15.6 （12-20） weeks, there was no iatrogenic injury of nerve and blood vessel, internal fixation loosening, broken screw and broken plate, re-displacement fracture and delay healing of fracture. All of the patients can walk 16 weeks after operation, and walk without limp 28 weeks after operation. According to Johner-Wruhs joint function evaluation standard, 25 cases were excellent, 6 cases were good, one case was general, no case was poor, the optimal rate was 96. 875%. Conclusion： Closed reduction by bone-setting manipulation of Tujia medicine combined with MIPPO technique for treating tibial fracture is effective, safe and reliable, and is conformed minimally invasive biological internal fixation principles.