伴严重软组织损伤的胫骨中下段骨折的微创治疗

Minimally invasive treatment of middle and distal tibia fractures accompanied with severe soft tissue injury

目的 探讨微创经皮钢板接骨术（minimally invasive percutaneous plate osteosynthesis,MIPPO）结合胫骨远端锁定钢板治疗伴严重软组织损伤的胫骨中下段骨折的临床疗效.方法 2008年10月至2011年12月采用MIPPO技术联合锁定钢板治疗伴严重软组织损伤的胫骨中下段骨折15例,其中闭合性10例,开放性5例.首先处理软组织损伤,闭合性损伤予抗炎、脱水、消肿,开放性损伤予清创、抗炎,待肢体肿胀消退、软组织无感染征象时进行内固定手术.骨折经闭合复位,经皮插入胫骨远端锁定钢板,以桥接方式固定,开放性损伤患者于内固定后对创面进行皮片或皮瓣覆盖.结果 所有病例均获随访,平均随访14.1个月（12 -20个月）,平均骨折愈合时间为17.3周（12 - 28周）,无骨不连、畸形愈合、内固定失败等并发症.术后定期复查X线片,随访结束时根据AOFAS评分系统进行踝关节功能评分,优12例,良2例,可1例,优良率93.3％.结论 MIPPO技术结合锁定钢板治疗胫骨中下段骨折具有软组织保护好、固定牢固、并发症少、允许早期功能锻炼等优点,是临床治疗胫骨中下段骨折的可靠方案.

Objective To evaluate the clinical effect of minimally invasive percutaneous plate osteosynthesis （MIPPO） combined with distal tibia locking plate in the treatment of middle and distal tibia fractures accompanied with severe soft tissue injury. Methods From October 2008 to December 2011,15 patients with middle or distal tibia fractures accompanied with severe soft tissue injury were treated in our department, using MIPPO combined with locking plate. Among them, 10 were closed fractures and 5 were open fractures. Firstly, the soft tissue injury was treated immediately when admitted. Anti-inflammatory, dehydration was taken to close fractured patients, and debridement, antiinflammatory was applied to open fractured patients. Operation would not perform until limb swelling subsided and there were no signs of infection. Closed reduction was accomplished first, and then a locking plate was inserted percutaneously and fixed the fracture on bridging mode. The wounds were covered with flaps after internal fixation for patients with open fractures. Results All cases were followed up for average 14.1 months （ranged from 12 to 20 months）. The healing time of fractures was 17. 3 weeks averagely （ ranged from 12 to 28 weeks ）. No complications, such as nonunion, malunion and failure of the internal fixation, occurred in the cases. X-ray examinations were taken regularly. The function of ankles was evaluated at the end of follow-up according to the AOFAS Ankle-Hindfoot Scale, and 12 cases were excellent,2 were good and 1 was fair, the ratio of excellent and good was 93.3 %. Conclusions MIPPO technique combined with locking plate is a clinically effective protocol for treating middle and distal tibia fractures, which benefits from its soft tissue protection, stable fixation, fewer complications and permit to early functional rehabilitation.