微创内固定技术治疗胫骨远端粉碎骨折.DOCVIP

临床医学论文-微创内固定技术治疗胫骨远端粉碎骨折 ???????????? 作者：钱越宁，胡铁铭，顾宣歆 【摘要】? 目的 介绍应用AO锁定加压接骨板(locking compression plate，LCP)实现微创经皮接骨板(minimally invasive percutaneous plate osteosynthesis，MIPPO)技术固定胫骨远端粉碎骨折的手术方法，探讨其临床疗效。方法 2004年5月至2006年10月，应用LCP实现MIPPO技术治疗胫骨远端粉碎骨折13 例，男7 例，女6 例，年龄23～62 岁，平均45 岁。AO分型43A2型7 例，43A3型3 例，43B1型1 例，43C1型1 例，43C2型1 例，其中有3 例骨折线延至胫骨中段。关节内骨折，行关节有限切开，坚强内固定；关节外骨折，按MIPPO技术要求间接复位，LCP桥接固定。结果 术后摄片测量肢体力线，与健侧对比，内外翻畸形、前后成角均小于等于±5°，无短缩、旋转畸形。采用电话预约门诊定期随访，全部病例随访4～18个月，平均12个月。平均愈合时间14.3周。无复位丢失，无内固定松动、断裂。根据美国足踝矫形外科学会制定的评定标准，从疼痛(40分)、踝关节功能(50分)和骨折对线(10分)方面进行评定。本组评分86～95分，平均92.5分。结论 MIPPO技术利用骨折间接复位技术，避免骨折端不必要的暴露，保护骨折端及其周围的血供，创伤小，固定可靠，有利于骨折的早期愈合及功能康复。对于胫骨远端粉碎骨折，应用LCP实现MIPPO技术固定应成为最佳选择。在X线监视下进行良好的间接复位是手术成功的保证。 【关键词】? 胫骨骨折；内固定；微创经皮接骨板 ??? A Minimally Invasive Percutaneous Plate Osteosynthesis (MIPPO) for Comminuted Fractures of the Distal Tibia ???? Abstract：Objective? To introduce the minimally invasive percutaneous plate osteosynthesis(MIPPO) techniques for comminuted fractures of the distal tibia with AO locking compression plates(LCP) and evaluate the clinical effect.Methods? From May 2004 to October 2006，13 patients with comminuted fractures of the distal tibia were treated with MIPPO techniques using AO LCPs.The mean age of the patients was 45 years(23～62 years) which consisted of 7 males and 6 females.According to the AO classification，there were 7 of 43A2 type，3 of 43A3 type，1 of 43B1 type，1 of 43C1 type and 1 of 43C2 type，among 3 patients with the fracture gaps extending into middle tibial.The intraarticular fractures were treated by limited open reduction and rigid fixation and the extraarticular components were bridged by LCP with MIPPO techniques.Results? All 13 patients were available at follow up by telephone appointment in outpatient wards with mean duration of 12 months(range，4～18 months) and achieved bone union(with an average of 14.3 weeks).Radiographic alignments were evaluated after operation and at the final followup.Compared with the normal si