踝关节镜下微创经皮钢板内固定治疗胫骨Pilon骨折的临床研究

目的探讨踝关节镜下微创经皮钢板内固定技术（MIPPO）治疗胫骨Pilon骨折的手术方法和临床疗效。方法本组47例患者运用关节镜下撬拨复位，行MIPPO治疗。38例获得随访，随访时间6—23个月，平均（10．6±5．4）个月。结果所有患者创口愈合良好，均在术后2周拆线。骨折临床愈合时间为6—18周，平均（9．5±4．2）周，无骨折不愈合。随访x线检查显示骨折对位对线良好，无畸形愈合，仅有3例胫骨远端关节面尚不平整，出现轻度骨关节炎的表现；仅1例主诉长距离行走后踝关节肿痛。按Mazur等踝关节症状和功能评分系统进行疗效评定，优24例，良19例，可4例。结论运用关节镜下撬拨复位尽可能保证重建后的踝关节面接近正常解剖，防止日后创伤性踝关节炎的发生。MIPPO的微创方法可以避免软组织广泛剥离，最大限度保留软组织的覆盖和血液供应，提高局部抗感染能力，促进骨折的愈合。

The clinical research about arthroscopy assisted minimally invasive plate fixation of tibial Pilon fractures

Objective To explore optimal surgical techniques and clinical outcome of Pilon fractures managed with arthroscopy-assisted minimally invasive plate fixation. Methods A consecutive series of 47 patients with pilon fractures was treated. Under arthroscopy, the fracture reduction was achieved within a small incision by the poking technique and then the plate was implanted with the minimally invasire percutaneous plate osteosynthesis （MIPPO） techniques. The outcomes were evaluated with the radiological results and Mazur ankle evaluation grading system. Results 38 patients were followed up 6 -3 （10. 6 ±5. 4） months. Healing of incisions and fractures was achieved in all cases. Radiologically, the fracture segments got satisfactory reduction with good apposition and alignment. The average time of fracture union was 6 -18 （9. 5 ±4. 2） weeks. No malunion or nonunion was observed. Rough joint surface of distal tibia and slight osteoarthritis was seen in 3 cases and only 1 case complained swelling and pain in ankle joint after a long walk. There were 24 excellent, 19 good and 4 fair ranked by the Mazur ankle evaluation grading system. Conclusions Anatomic reduction of ankle joint surface can be achieved by arthroscopyassisted poking reduction so as to prevent traumatic osteoarthritis of ankle joint. MIPPO techniques can help to reduce soft tissue injury, maintain coverage and blood supply, therefore enhance fracture healing.