微创固定治疗胫骨远端粉碎性骨折

目的：探讨微创固定治疗胫骨远端粉碎性骨折的疗效。方法：自2002年至2008年共治疗胫骨远端粉碎性骨折48例，其中男41例，女7例；年龄21-68岁，平均44．5岁。采用闭合复位微创固定腓骨，胫骨较大骨块用撬拨法复位，恢复踝穴位置及下肢力线后再用克氏针或螺钉固定，术后6周开始部分负重及踝关节功能锻炼。结果：48例均获随访，时间1-24个月，平均12个月。48例均骨性愈合，按Johner-Wrubs评定标准（从疼痛、畸形、关节活动度及是否伴神经血管损伤等方面评定）：优38例，良8例，中2例，优良率95．8％。结论：微创固定具有操作简易，软组织损伤少，固定可靠的优点，并能最大限度保护骨膜，是治疗胫骨远端粉碎性骨折的可选方法。

Less invasive fixation for the treatment of comminuted fracture of distal tibia

Objective: To study the result of less invasive fixation in treating comminuted fracture of distal tibia. Methods: From 2002 to 2008,48 patients with comminuted fracture of distal tibia were treated with surgery. The closed reduction and less invasive fixation were done to stable broken fibula,and the reduction by Kirschner wire to pick was used for relatively larger debris of tibia. The Kirschner wire or screw were used to fix fracture after the restore of the ankle cavity position and the alignment of the tibia. Partial weight loading and functional exercise of ankle joint were done at 6th week after operation. Results: Forty-eight patients were followed up for 1-24 months with an average of 12 months. All the fractures were united. According to Johner-Wruhs standard to value the result by factors of pain,deformity,motion range of joint,with or without injury of nerve and blood vessel. Thirty-eight cases obtained excellent result,8 good,fair 2. The rate of excellent and good were 95.8%. Conclusion: Less invasive fixation has ascendancy such as easy operation,less injury of soft tissue,reliable fixation,which can maximally protect periosteum. It is a choice for treating comminuted fracture of distal tibia.