微创技术在胫腓骨Gustilo Ⅲ型骨折治疗中的应用

Effect of minimally invasive percutaneous plate osteosynthesis in the treatment of Gustilo type Ⅲ tibiofibular fractures

目的探讨微创经皮钢板植入技术治疗胫腓骨GustiloⅢ型骨折的疗效。方法收集2012年5月至2016年9月德阳市第二人民医院骨科收治的25例胫腓骨GustiloⅢ型骨折,其中男性14例,女性11例;年龄17~65岁,平均40.3岁;GustiloⅢA型13例,GustiloⅢB型9例,GustiloⅢC型3例。所有患者均行急诊清创缝合闭合创面,骨折复位克氏针有限内固定,皮肤缺损严重者采用负压封闭引流技术(VSD)封闭伤口。后期感染及并发症控制后采用微创技术(MIPPO)行内固定骨折。随访10~25个月,平均15个月。结果 1例骨不连,24例骨折愈合,愈合时间7~21个月,平均13.1个月。采用Johner-Wruhs标准对患肢膝、踝关节进行功能评分,其中优15例,良8例,差2例,优良率为92.0%(23/25)。结论开放性GustiloⅢ型骨折采用MIPPO技术能减少软组织破坏,有利于恢复血供,利于骨折愈合,值得临床推广。

Objective To investigate the curative effect of minimally invasive percutaneous plate osteosynthesis（MIPPO） in the treatment of Gustilo type Ⅲ tibiofibular fractures. Methods Twenty-five cases of Gustilo typeⅢ tibiofibular fractures treated in Department of Orthopaedics, Deyang Second People＇s Hospital from May 2012 to September 2016 were selected, including 14 males and 11 females, aged 17 to 65 years old（40.3 years old in average）.Among them, there were 13 cases of Gustilo type-ⅢA, 9 cases of Gustilo type-ⅢB, and 3 cases of Gustilo type-ⅢC.All patients underwent emergency debridement and suture closure of the wound, and fracture reduction and internal fixation with Kirschner wire. Severe skin defects were closed with vacuum sealing drainage（VSD）. After the control of late infection and complications, MIPPO was used for internal fixation. All the patients were followed up for 10 to 25 months, 15 months in average. Results There was 1 case of nonunion and 24 cases of fracture healing, with healing time of 7 to 21 months, 13.1 months in average. Johner-Wruhs criteria was used to evaluate the function of knee and ankle joints. Among them, 15 were excellent, 8 were good, and 2 were poor, with the excellent and good rate of 92.0%（23/25）. Conclusion The use of MIPPO technology in open Gustilo Ⅲ fractures can reduce the destruction of soft tissue, help restore blood supply, facilitate fracture healing, which is worthy of clinical promotion.