微创经皮钢板内固定技术结合前外侧单一切口入路治疗开放性胫腓骨远端骨折

Minimally invasive percutaneous plate internal fixation through anterolateral single incision for the treatment of open distal tibiofibula fractures

目的:探讨经皮微创钢板内固定(minimally invasive percutaneous plate osteosynthesis,MIPPO)技术结合前外侧单一切口入路Ⅰ期治疗胫腓骨远端开放性骨折的临床疗效。方法:自2015年3月至2019年2月对10例开放性胫腓骨远端骨折患者行单一前外侧切口结合MIPPO技术治疗,其中男8例,女2例;年龄31~68岁。开放性骨折根据Gustilo分型,Ⅰ型6例,Ⅱ型3例,ⅢA1例。观察患者的手术时间、术中出血量、骨折愈合情况,采用Mazur踝关节功能评分进行临床疗效评价。结果:10例患者均获得随访,时间9~24个月。手术时间85~120 min,术中出血量80~200 ml,骨折愈合时间18~30周。9例Gustilo分型为Ⅰ、Ⅱ型患者伤口均取得满意愈合,1例GustiloⅢA期患者原创口愈合差,给予Ⅱ期皮瓣移植取得愈合,所有患者无钢板外露及感染发生。末次随访时根据Mazur踝关节评分,总分61~97分,其中优8例,良1例,差1例。结论:MIPPO技术结合小腿前方单一前外侧切口治疗胫腓骨远端开放性骨折,术中保护原内侧切口,通过前外侧伸肌群覆盖内固定物避免钢板外露,MIPPO技术微创操作保护骨折端血供提高骨折端愈合率,是一种可选择的手术方式。

Objective:To investigate therapeutic effect of minimally invasive percutaneous plate internal fixation(MIPPO)through a single incision in treating open distal tibiofibula fractures.Methods:From March 2015 to February 2019,10 patients with open distal tibiofibula fractures were treated with MIPPO technique through single anterolateral incision,including 8 males and 2 females,aged from 31 to 68 years old.According to Gustilo classification,6 patients were typeⅠ,3 patients were typeⅡand 1 patient was typeⅢA.Operative time,intraoperative blood loss and fracture healing were observed,Mazur ankle joint scoring was used to evaluate clinical effect.Results:All patients were followed up from 9 to 24 months.Operative time ranged from 85 to 120 min,intraoperative blood loss ranged from 80 to 200 ml,fracture healing time ranged from 18 to 30 weeks.Nine patients with Gustilo typeⅠandⅡachieved satisfactory healing wound,original wound of 1 patient with Gustilo typeⅢA was poor,and healed by skin flap transplantation at stageⅡ.No steel exposed and infection occurred.According to Mazur ankle scoring at the final following-up,total score was from 61 to 97,and 8 patients got excellent result,1 good and 1 poor.Conclusion:MIPPO technique through anterolateral single incision for the treatment of open distal tibiofibula fractures could protect original medial wound in opertaion,avoid plate exposed through anterolateral extensor tendon to cover internal fixation,and MIPPO technique could protect fracture end blood flow to improve fracture healing rate,and it is a kind of choice.