结合外支架复位经皮钢板固定治疗胫骨远端骨折疗效分析

目的胫骨远端骨折是一种比较常见的高能量骨折，我们采用外固定支架临时复位，经皮钢板内固定治疗胫骨远端骨折，并评价其疗效。方法以2004年10月至2005年4月来我院治疗胫骨远端骨折的患者为研究对象，开放性胫骨远端骨折不在本次的研究范围之内。所有患者入院后均行择期手术，手术时先利用外固定支架复位，维持下肢力线，后通过内踝远端小切口逆行将钢板插入皮下，进行固定。关闭切口后去除外固定支架。术后要求患者早期负重锻炼。结果平均手术时间74．9min，其中外支架固定时间10．6min。钢板平均9．4孔；使用螺钉7．8枚。住院平均时间7．5d。所有患者均未出现切口感染及皮肤坏死。本组患者的随访时间为8～24个月，平均15．4个月。在32例骨折中．24例（75％）6月内骨折愈合，平均愈合时间4．7个月。5例（15．6％）骨延迟愈合，平均愈合时间为8．6个月。3例（9．4％）出现骨不连，其中2例通过髂骨植骨在植骨后6个月骨折愈合，1例未愈。8例患者出现踝关节活动受限：8例患者诉小腿前内侧钢板放置处疼痛不适。结论结合外固定支架经皮钢板固定是一种治疗胫骨远端骨折的有效且可靠的方法。

Clinical Observation About Percntaneons Plate Osteosynthesis with external Fixator for Distal Tibia Fractures

Objective To summarize the clinical use of minimally invasive percutaneous plate osteosynthesis （MIPPO） with external fixator in the treatment of distal tibia fractures and to investigate its clinical effects. Methods From September 2004 to April 2005, 32 patients suffered from closed distal tibia fractures were selected to this study. There were 28 males and 4 females, aged 21-45 years old （32.6 years on average）. All the patients were treated delayed operation. The first step was indirect reduction by unilateral external frame. When the reduction was satisfied under C-arm machine, a gently curving 3 cm incision was made 2 cm distal to the medial malleolus. Long-curved Mayo scissors are then inserted gently in the plane beginning over the deltoid ligament in line with the mid-line of the subcutaneous border of the tibia. The plate is then gripped at its distal end using a Kocher＇s forcep and inserted via the distal incision in a retrograde fashion. After the LCP was fixed, the unilateral external frame was removed. The patients were ordered partial weight-bearing early stage. Results All incisions obtained healing by first intension. The delayed operation time was 3-14 days with on average of 5.4 days. The average operation time was 74.9 rain （range 47-123 rain）. The average follow-up time was 15.4 months （ranged 8-24 months）. In all 32 cases, 24 cases got bone union at 6 months after operation with an average 4.7 months. Delayed bone union appeared in 5 cases with an average 8.6 months after operation. Non-union appeared in 3 cases. But 2 of them got bone union 6 months after iliac bone transplantation. Conclusion The combined use of this simple quadrilateral frame along with MIPPO insertion of the AO anatomical distal LCP is a simple and reliable surgical strategy, which can be readily applied in these difficult injuries. MIPPO combined external fixator is beneficial for distal tibia fractures healing and reconstruction of soft tissue.