MIPO技术治疗胫骨骨折

2006年6月～2008年8月,我科采用MIPO（minimally invasive percutaneous plate osteosynthesis）技术治疗胫骨骨折24例,取得较满意的疗效：     

Technical note: How to spare the pronator quadratus during MIPO of distal radius fractures by using a mini-volar plate

Few surgical approaches have been described that spare the pronator quadratus (PQ) during the treatment of distal radius fractures. The PQ supplies blood to the distal radial epiphysis, helps stabilize the distal radio-ulnar joint, and contributes 21% of pronation strength. Sparing the PQ should result in faster bone union and shorter recovery time. To achieve these goals, we currently use a minimally-invasive volar procedure using a specially-designed short plate (APTUS Wrist 2.5 XS, Medartis^©). A 20 mm incision is made over the fracture line as described by Henry. The PQ is dissected and then detached from the volar side of the radius. Forceps are used to slide the plate under the muscle. The screws are locked after carefully elevating the distal edge of the PQ. A preliminary study of distal radius fracture fixation by this technique was performed in 31 patients. The scar was 26 mm in length and the duration of surgery was 34 minutes on average. Patients wore a removable brace for 15 days, and passive wrist motion without loading was allowed during the first week. Functional recovery was faster than seen in previously published series. An average Quick DASH score of 10 was achieved by the 10th post-operative week. Although there are no contraindications to this technique, the quality of the reduction is more important than the scar size and desire to spare the PQ. Never hesitate to convert the incision to a classical Henry approach if technical difficulties arise. Our technique seems best suited to patients with high functional demands. It is currently being evaluated in a prospective series.     

从AO传统加压接骨板到新型内固定器原则

骨折内固定中生物学的重要性和保护骨和软组织，作为AO的第4项原则已受重视。AO传统加压接骨板对骨面的压迫会干扰骨皮质的血运，引起接骨板下方骨的结构性改变。有限接触动力加压接骨板(LC—DCP)可减小接骨板和骨的接触面积。锁定螺丝钉(LHS)、点接触固定器(PC Fix)及微创固定系统(LISS)设计则因接骨板与骨面无接触和压迫，是新的一次变革。这种内固定器原理的概念可以用外固定支架来理解，可以防止任何对骨血运的破坏，其稳定性依赖于螺丝钉一接骨板组合的成角稳定性。带有锁定螺丝钉的新型微创固定系统(LISS)和锁定加压接骨板(LCP)可以为现代骨折手术治疗提供新的选择方法，是微创经皮接骨板技术(MIPO)的理想材料，并可以在疏松骨质内得到相当好的固定强度。然而，必须指出这些新型接骨板和螺丝钉并不能解决所有的问题，特别是在处理干骺端和骨干部骨折时，它们每一步的操作都需要有非常仔细的计划，包括重温AO经典的原则。     

Experimental analysis of the minimally invasive plate osteosynthesis technique applied with non-locking screws and screw locking elements

Minimally invasive plate osteosynthesis (MIPO) is an effective surgical technique in the repair of humeral and tibial shaft fractures. There is some controversy as to the minimum number of screws required to ensure correct stability to promote healing, especially when dealing with low quality bones. This work compared different systems assembled on synthetic models simulating a comminuted fracture. Group 1 comprised a locking compression plate with four non-locking screws placed at the holes furthest from the fracture. Group 2 differed from group 1 only in the additional use of two screw locking elements (SLE). Group 3 had four rather than two SLE and, finally, Group 4 used 4 locking screws. The compression and torsion tests with static and cyclic loads showed that, in MIPO, two locking screws or two non-locking screws with SLE could be used per segment without any significant loss in stiffness after 1000 cycles, with system stability guaranteed in both cases. However, lower strength and significant loss of stiffness were observed when non-locking screws were used alone.     

应用锁定钢板结合MIPO治疗老年骨质疏松性肱骨近端骨折的临床疗效分析

目的 探讨锁定钢板联合微创接骨板接骨术（MIPO）治疗老年骨质疏松性肱骨近端骨折的疗效.方法 40例患者随机分配到对照组和观察组,对照组采用常规锁定钢板治疗,观察组采用锁定钢板联合MIPO治疗.通过Neer百分制评分和术后并发症来评定治疗的疗效.结果 对照组治疗优良率为80.0％,观察组治疗优良率为95.5％,两组优良率对比差异具有统计学意义（P＜0.05）.对照组术后并发症发生率为35.0％,观察组并发症发生率为10.0％,两组并发症对比差异具有统计学意义（P＜0.05）.结论 锁定钢板联合MIPO能够提高治疗老年骨质疏松性肱骨近端骨折的治疗疗效,有效减少并发症的发生,值得临床推广.     

Percutaneous Plating of Weber B Fibular Fractures

The purpose of the present study was to describe a minimally invasive percutaneous technique for plating Weber B distal fibular fractures and to evaluate its efficacy by measuring patient outcomes and hardware removal rates. The data from 17 patients undergoing percutaneous plating of a distal fibular (Weber B) fracture were prospectively studied. A 4- to 6-hole semitubular plate with 3 screws was used for percutaneously plating. The Roles and Maudsley score was used to assess the patients’ activity level. All fibular fractures had healed clinically and radiographically by 8 weeks after surgery. The postoperative Roles and Maudsley scores had improved significantly. The time required to return to activity was 4.3 ± 2.0 months. Hardware removal was required in 3 patients during the study period, which had an average of almost 4 years postoperatively. The results of the present study have demonstrated that percutaneous plating is an effective surgical option for treating Weber B distal fibular fractures.     

Tibial plateau fractures: internal fixation with locking plates and the MIPO technique

Proximal tibial fractures are difficult lesions to treat because of the involvement of the articular surface, the often occurring comminution, and the precarious condition of the soft tissues, especially following high-energy trauma. Aim of the treatment is to restore the congruence of the articular surface supporting the tibial plateau cartilage which is usually depressed; to fix the fracture with a stable device; to allow early rehabilitation.We present our treatment strategy, utilising closed or open reduction and internal fixation, angle-stable polyaxial plates, immediate osteointegration, when necessary, with autologous bone graft or other osteoconductive material augmented with autologous platelet gel. Surgery is soft-tissue dependent in terms of timing, and it is usually performed directly or under supervision of an experienced surgeon utilising, whenever possible, a tissue sparing technique.A cohort of 58 proximal tibial fractures, surgically treated, from January 2004 to June 2007, was retrospectively reviewed. Fractures were classified according the OTA/AO classification. The assessment of the functional outcome with the use of the Rasmussen score identified good to excellent results in 78% of the cohort 12 months post-surgery.Internal fixation with locking plates, following the principles of MIPO (Minimally Invasive Percutaneous Osteosynthesis), provides satisfactory fracture reduction with good results regarding the mid-term clinical outcome.     

MIPO技术双钢板治疗Ⅴ～Ⅵ型胫骨平台骨折的疗效观察

目的观察MIPO（Minimally invasive percutaneous osteosynthesis）技术联合双钢板治疗Ⅴ～Ⅵ型胫骨平台骨折的疗效。方法采用MIPO技术联合双钢板治疗Ⅴ～Ⅵ型胫骨平台骨折27例,其中开放性骨折3例,闭合性骨折24例;根据Schatker分型,Ⅴ型21例,Ⅵ型6例。随访时膝关节功能根据Hss评分评价疗效。结果 27例均获随访,平均随访时间15个月。膝关节功能根据Hss疗效标准评价：优18例,良5例,可4例,差3例;总优良率85.2%。所有患者骨折复位满意,无骨折延迟愈合或不愈合,无伤口感染、皮肤坏死等并发症。结论采用MIPO技术联合双钢板治疗Ⅴ～Ⅵ型胫骨平台骨折,骨愈合率高,并发症少,是治疗Ⅴ～Ⅵ型胫骨平台骨折的有效方法。