两种方式治疗胫骨中下段骨折的疗效比较

目的 比较经皮微创锁定钢板内固定(MIPPO)和交锁髓内钉内固定治疗胫骨中下段骨折的疗效.方法 将90例胫骨中下段骨折患者按治疗方法 不同分为髓内钉组(采用交锁髓内钉内固定治疗,40例)和MIPPO组(采用MIPPO治疗,50例).记录并发症情况和骨折愈合时间.术后1年采用Johner-Wruhs评分和疼痛VAS评分评...     

两种内固定治疗胫骨中下段骨折的疗效比较

目的 比较交锁髓内钉和微创经皮锁定钢板固定治疗胫骨中下段骨折的疗效。方法 将100例胫骨中下段骨折患者按内固定方式不同分为交锁髓内钉组(采用交锁髓内钉固定治疗,50例)和锁定钢板组(采用微创经皮锁定钢板内固定治疗,50例)。比较两组手术情况、骨折愈合时间、术后部分负重行走时间、术后并发症发生情况、Johner-Wruhs评分、踝关节活动度、AOFAS踝-后足评分。结果 患者均获得随访,时间12～15(12.26±5.63)个月。术中出血量、切口长度、住院时间：交锁髓内钉组均少(短)于锁定钢板组(P<0.01)。骨折愈合时间：交锁髓内钉组短于锁定钢板组(P<0.01)。术后部分负重行走时间：交锁髓内钉组早于锁定钢板组(P<0.01)。术后并发症发生率：交锁髓内钉组低于锁定钢板组(P<0.05)。术后12个月Johner-Wruhs评分优良率、末次随访时踝关节活动度及术后3、12个月AOFAS踝-后足评分：交锁髓内钉组均优于锁定钢板组(P<0.05)。结论 与微创经皮锁定钢板内固定相比,交锁髓内钉固定治疗胫骨中下段骨折更符合力学原理,更利于骨折愈合,患者术后下...     

两种内固定治疗胫骨下段骨折的疗效比较

目的 比较带锁髓内钉(IMN)固定和微创经皮钢板内固定(MIPPO)治疗胫骨下段骨折的疗效.方法 将140例胫骨下段骨折患者按手术方式不同分为IMN组(采用IMN固定治疗,70例)和MIPPO组(采用MIP-PO治疗,70例).比较两组手术情况及治疗效果.结果 患者均获得随访,时间6～12(9.31±1.23)个月.术...     

旋入自锁髓内钉固定治疗42例胫骨新鲜闭合性骨折效果观察

目的探讨旋入自锁髓内钉固定治疗胫骨新鲜闭合性骨折的效果。方法选取2017-06-2019-06间收治的84例新鲜闭合性胫骨骨折患者,按照手术方法不同分为2组,各42例。交锁组采用交锁髓内钉固定术,自锁组采用旋入自锁髓内钉固定术。回顾性分析2组的治疗效果。结果自锁组手术时间及术后下地活动时间、骨折愈合时间短于交锁组,治疗优良率高于交锁组,差异均有统计学意义(P<0.05)。2组术后并发症发生率差异无统计学意义(P>0.05)。结论旋入自锁髓内钉固定治疗胫骨新鲜闭合性骨折,可缩短手术时间及术后患者下地活动时间,有利于加快骨折愈合,效果显著。     

交锁髓内钉治疗股骨、胫骨干粉碎性骨折

目的：交锁髓内钉治疗股骨、胫骨干粉碎性骨折临床观察。方法：应用小切口切开复位，选择性扩髓，交锁髓内钉内固定治疗股骨，胫骨干粉碎性骨折26例，结果：本组26例随访时间6－24个月，平均14个月，骨折平均愈合时间14周，无术后感染，脂肪栓塞，断钉，骨折不愈合，畸形愈合，关节僵硬，再骨折等严重并发症发生，结论：本组股骨、胫骨干粉碎性骨均属不稳定型骨折，交锁髓内钉固定疗效是确切的，可采用小切口切开复位并选择性扩髓，不主张早期负重或做动力化处理。     

小切口钢板内固定治疗胫骨骨折两种置钉方式疗效比较

目的探讨微创钢板固定法(MIPO)治疗胫骨骨折中连续置钉与间隔置钉两种固定方式的临床疗效并进行对比。方法采用MIPO技术治疗46例胫骨中段骨折,连续置钉组22例,间隔置钉组24例。术后24 h内均不负重状态下功能锻炼。对比分析两组手术时间、术中出血量、完全负重时间、骨折愈合时间及术后Johner-Wruhs评分以及内固定断裂发生率。结果所有患者均获得平均14.8(12~24)个月随访。两组手术时间、术中出血量及末次随访Johner-Wruhs评分的差异均无统计学意义(P>0.05)。连续置钉组骨折愈合时间与完全负重时间较间隔置钉组延长,内固定断裂发生率更高。结论采用MIPO技术治疗胫骨干骨折时,间隔置钉的固定方法可避免应力过于集中,降低内固定断裂的风险,有利于加快骨折愈合,能使患者早期负重。     

带锁髓内钉治疗胫骨骨折临床疗效分析

目的探讨带锁髓内钉治疗胫骨骨折的临床效果。方法对2000年1月至2006年1月期间78例胫骨骨折应用带锁髓内钉扩髓内固定治疗,其中男47例,女31例,开放性骨折32例(G ustiloⅠ度11例,Ⅱ度21例),行闭合复位38例,术后第1天开始应用CPM进行关节功能锻炼。结果75例随访4~28个月,平均13个月。骨折愈合时间6~30周,平均14周。骨延迟愈合2例,无断钉、骨髓腔感染、脂肪栓塞、关节僵硬及再次骨折等并发症。结论交锁髓内钉治疗胫骨骨折具有创伤小、固定坚强、骨折愈合率高、能早期活动、感染率低等优点,可作为治疗胫骨骨折的内固定方法。     

Minimally invasive plate osteosynthesis (MIPO) in the treatment of the femoral shaft fracture where intramedullary nailing is not indicated

The aim of this study was to examine the results of minimally invasive plate osteosynthesis (MIPO) of the femoral shaft fracture in patients where intramedullary nailing is contraindicated and evaluate the proper number of the screws for stable fixation. This was a retrospective study of 36 closed femoral shaft fractures which underwent MIPO using a conventional 4.5 broad dynamic compression plate (DCP) with 14-18 holes fixed with three or four screws in the proximal and distal fragments. Thirty-three fractures had bony union in 21.0 weeks (range, 12-28 weeks), two had delayed union that required bone graft and union at 28 and 32 weeks. Malalignment occurred in five cases. Sixty-two fragments were fixed with three screws--40 in cluster and 22 in separated positions. Ten fragments were fixed with four screws--eight in cluster and two separated. Broken screws were found in three cases; all were in the group with three screws fixed in cluster group. MIPO of the femoral shaft fracture is an alternative treatment in the patient where intramedullary nailing is contraindicated. Malalignment is the common complication that must be carefully evaluated intraoperatively. We recommend using at least three separated screws in each fragment to reduce the risk of screw breakage.     

Effectiveness of sonography assisted minimal invasive plate osteosynthesis (MIPO) compare with fluoroscope assisted in femoral shaft fracture: A cadaveric study

IntroductionA minimal invasive plate osteosynthesis (MIPO) has an advantage of biological soft tissue preservation that consists of preserving bony blood supply, fracture hematoma and less soft tissue damage which leads to decreasing of infection rate and rapid bone healing. However, the radiation exposure is still a disadvantage of this technique. A sonography that provides dynamic real time imaging may be used as an alternative technique for assisting MIPO. The aim of this study was to compare the effectiveness of MIPO in femoral shaft fracture between the sonography assisted and the fluoroscopy assisted.MethodsTwenty-eight cadaveric limbs were subjected to create femoral shaft fracture. Then, sonography assisted reduction with temporary external fixation and MIPO were performed. Images of the sonography and the fluoroscopy were recorded including before reduction, after reduction and after MIPO in order to identify fracture displacements in anteroposterior and mediolateral directions. Moreover, the anterior and posterior distances from edge of the bone to the plate were measured to confirm plate position. The effectiveness of this technique was defined as the proper plate position and acceptable alignment after fixation. All distances from the sonography and the fluoroscopy were also analyzed and compared using Pearson correlation and Bland-Altman method to assess the agreements between two tests.ResultAll of the subjects were met the criteria for acceptable alignment. We found only three femoral shaft fracture (11%) operated with MIPO by sonography assisted that showed slipped plate off femoral bones. According to Pearson correlation, there were good to excellent agreements in term of measuring fracture displacement before (Pearson Correlation >0.7) and after reduction (Pearson Correlation >0.7) between these two tests. There was moderate agreement regarding to evaluation of plate position (Pearson Correlation 03.–0.7). When we compared two methods of measurement using Bland-Altman plot, there were no statistical significant difference (P < 0.05).ConclusionImages from the sonography could provide visualization of the fracture during reduction and MIPO as accurately as the radiography. Thus, the sonography assisted MIPO in femoral shaft fracture can be done effectively comparing with radiographic assisted.     

Evolution of minimally invasive plate osteosynthesis (MIPO) in the femur

Problems with conventional open reduction and internal plate fixation of distal femoral fractures are well established. These problems have been associated with extensile exposures of the fracture site. "Biological plating", like intramedullary nail fixation, of distal femoral fractures preserves the soft tissues about the fracture, and is associated with early fracture consolidation and low rates of infection. Anatomical restoration of the articular surface continues to be the main goal in the treatment of these fractures regardless of the stabilization technique. Submuscular plating techniques, which provide for closed reduction of the diaphyseal/metaphyseal component of the fracture, have improved significantly.     

Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures

PurposeTreatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods.MethodsThis was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups. The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, nonunion, superficial and deep infection between the two groups. Statistical analyses were performed using the SPSS software (version 16.0).ResultsAverage malunion (degrees) in the MIPPO group was 5 (3–7) ± 1.41 vs. 10.22 (8–14) ± 2.04 in the IMIL group (p = 0.001). Similarly postoperative knee pain in the IMIL group was 10% vs. 2% in the MIPPO group (p = 0.001). In terms of superficial infection and nonunion, the results were 8% vs. 4% and 2% vs. 6% for the MIPPO and IMIL group, respectively (p = 0.001).ConclusionBoth procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.     

经皮微创钢板接骨术治疗胫骨近侧干骺端骨折的临床观察

[目的]总结经皮微创钢板接骨术（MIPPO）治疗胫骨近侧干骺端骨折的手术方法和临床效果。[方法]采用MIPPO技术治疗胫骨近侧干骺端骨折患者25例，其中男18例，女7例，平均年龄42．6岁（21-66岁）。按AO分型：41—A型17例，41-C型8例。其中多发伤8例，开放性骨折4例（Gustilo Ⅱ2例，ⅢA2例）。[结果]本组手术时间70～115min，平均90min；术中平均失血260ml，无输血。无浅表和深部感染发生。全部病例均获得随访，随访时间1—2．5a，平均1．8a。X线片愈合时间13．8周（10-20周）；患者完全负重时间为14．5周（11—28周）。无畸形愈合和内固定失效。按Johner-Wruch评分标准，优14例，良9例，可2例，优良率92％。[结论]MIPPO在治疗胫骨近侧干骺端骨折中具有创伤小、固定确实、感染率低、骨折愈合率高等优点，符合生物学固定理念，是一种有效的治疗方法。     

经皮微创钢板固定法治疗胫骨干骺端骨折

目的 探讨经皮微创钢板固定法治疗胫骨干骺端骨折的临床疗效。方法 32例涉及胫骨干骺端的骨折，其中男性19例，女性13例。患者平均年龄42.5岁(25～64岁)。按AO分型，A型(不涉及关节面)12例；B型(伴有部分关节内骨折)11例；C型(伴有完全关节内骨折)9例。其中，胫骨近端18例，胫骨远端骨折14例。结果 患者完全负重时间为15.1周(12～26周)；X线愈合时间为14.3周(11-24周)。按照Johner-Wruhs评价法，功能优为19例，良为10例，中为3例，差为0例，优良率为90.6％。浅表感染2例，皮肤水疱3例；无深部感染及皮肤坏死。结论 微创钢板固定法手术创伤小，骨折愈合率高，固定可靠，是治疗胫骨干骺端骨折的有效治疗手段。在X线监视下进行良好的间接复位是手术成功的保证。     

经皮微创锁定加压钢板内固定治疗胫骨远段骨折

[目的]观察经皮微创锁定加压钢板内固定治疗胫骨远段骨折的疗效。[方法]采用闭合复位经皮微创锁定加压钢板内固定治疗胫骨远段骨折52例。[结果]随访13~25个月。无骨折不愈合或畸形愈合,无内固定松动、断裂及严重移位。骨折临床愈合时间为9~22周,平均15周。根据Johner-Wruhs评定标准,优38例,良10例,可4例,差0例,优良率92.3%。[结论]经皮微创锁定加压钢板内固定是治疗胫骨远段骨折的一种较好的治疗手段。