微创经皮钢板固定术联合锁定钢板治疗胫腓骨中下段骨折的疗效分析

Clinical effectiveness of MIPPO combined with locking compression plate in treatment of middle and lower tibiofibula fracture

目的评价微创经皮钢板固定术（minimally invasive percutaneous plate osteosynthesis,MIPPO）联合锁定加压钢板（locking compression plate,LCP）治疗胫腓骨中下段骨折的临床疗效。方法回顾性分析2010年1月至2013年6月我院收治的胫腓骨中下段骨折病例90例,按手术方法分为两组：MIPPO组,45例,应用MIPPO技术联合LCP治疗;传统术式组,45例,采用传统切开复位内固定手术。记录并分析两组病例的手术治疗指标和骨折愈合效果。结果随访时间3.0-24.0个月,平均随访18.5个月。MIPPO组与传统术式组相比,在伤口长度（胫腓骨累计切口长度）、出血量、住院时间、平均放射量、伤口甲级愈合率、Johner-Wruhs功能评分优良率、骨折愈合时间这几个方面,MIPPO组较传统术式组优势明显,差异均有统计学意义（P〈0.05或P〈0.01）,无骨折延迟愈合及不愈合等并发症。结论 MIPPO技术联合LCP治疗胫腓骨中下段骨折,既符合生物力学原理,又增强钢板抗扭转及剪切应力,增加骨折稳定性及踝关节稳定性,促进骨折的愈合,能够减少患者创伤,减少并发症,值得推广。

Objective To evaluate the clinical effectiveness of MIPPO combined with locking compression plate （LCP） in the treatment of middle and lower tibiofibula fracture. Methods Ninety cases of middle and lower tibiofibula fracture from Jan. 2010 to Jun. 2013 in our hospital were divided into two groups： the MIPPO group （n = 45） and the control group （n = 45） given MIPPO ＋ LCP treatment, and opened reduction internal fixation, respectively. The therapeutic effects were analyzed. Results The mean follow-up time was 18.5 months （range from 3. 0 months to 24. 0 months）. As compared with the control group, the MIPPO group had obvious advantages at the size of the wound, bleeding volume, wound healing rate and the satisfaction of Johner-Wruhs score. The healing time of fracture and hospital stay in the MIPPO group were shorter than in the control group. There were no complications such as delayed union or nonunion of the fracture. Conclusion The treatment for middle and lower tibiofibula fracture with MIPPO and LCP not only conforms to the biomechanical principle, but also has advantages in reinforcing the anti torsion and shear stress of the internal fixation plate, increasing the stability of the fracture and the ankle joint, higher healing rate in fracture, reducing the trauma of patients and having less complications.