锁定钢板微创治疗胫骨远端骨折的疗效分析

目的探讨应用经皮解剖型锁定钢板内固定术治疗胫骨远端骨折的方法及疗效。方法采用经皮微创解剖型锁定钢板内固定治疗术治疗胫骨远端骨折30例。结果 30例随访10～24个月,未出现骨折延迟愈合及不愈合,根据Mazuretal的踝关节症状和功能评价标准,优良率为93.3%。结论应用经皮微创解剖型锁定钢板内固定治疗胫骨远端骨折,具有手术创伤小,骨折愈合快,术后并发症少,肢体功能恢复良好等特点。解剖型锁定钢板内固定术是治疗胫腓骨远端骨折的一种理想内固定方法。     

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.     

经皮微创锁定加压钢板内固定治疗老年股骨粗隆间骨折

[目的]探讨经皮微创钢板接骨术(MIPPO)结合锁定加压钢板(LCP)内固定治疗老年股骨粗隆间骨折的手术方法及临床效果.[方法]对2008年4月～2009年10月本院收治的20例股骨粗隆间骨折患者采用MIPPO技术结合LCP进行内固定治疗.其中男9例,女11例,年龄72～92岁,平均81岁.Tronzo-Evans分型:Ⅰ型2例,Ⅱ型3例,Ⅲ型10例,Ⅳ型3例,Ⅴ型2例.[结果]20例均获随访,随访时间12～30个月,平均18个月.愈合时间11～14周,仅1例不愈合.无感染、深静脉血栓、骨折不愈合、内固定松动、断钉并发症.术后功能按Hams评分:优15例、良4例、可1例,优良率95%.[结论]MIPPO技术结合LCP内固定治疗老年股骨粗隆间骨折,手术时间短,术中创伤小,固定简约可靠,术后骨折愈合率高,并发症少,功能良好,是治疗老年股骨粗隆间骨折的良好方法.     

Surgical technique for minimally invasive fibula fracture fixation

This paper describes a minimally invasive percutaneous technique for reduction and fixation of distal fibula fractures using plate osteosynthesis. We believe this technique benefits patients with poor quality soft tissue envelopes. So far a total of 25 patients have undergone percutaneous fixation, 22 females and 3 males. At no stage yet has a minimally invasive procedure been abandoned intra-operatively in favour of conversion to an open procedure. The mean age was 61.6 years (range 25–80 years). The mean time to surgery was 2.00 days (range 0–5) and mean time to discharge was 4.20 days (range 1–9). At a minimum of over 1 year's follow-up all fractures have healed, with no delayed unions or complications so far experienced.     

经皮钢板固定治疗胫骨远端骨折

目的:介绍微创经皮插入接骨板内固定治疗胫骨远端骨折,并观察其效果。方法:采用闭合复位经皮插入接骨板内固定治疗胫骨远端骨折36例。AO分型:A型23例(A2型9例,A3型14例),B型9例,C型4例。术后不辅以其他外固定,第2天即开始不负重关节功能锻炼。结果:所有患者随访6～22个月,平均11个月。随访36例,所有病例伤口一期愈合。骨折无延迟愈合,无畸形愈合,平均临床愈合时间17周。根据Mazur的踝关节功能评分,优良率94.4%。结论:微创经皮插入接骨板内固定术是治疗胫骨远端骨折的有效方法。     

微创锁定加压钢板内固定治疗股骨干粉碎性骨折的临床疗效分析

目的：观察对股骨干发生粉碎性骨折的12例患者应用LISS（微创稳定系统）进行内固定治疗的临床效果。方法：回顾本院2009年8月～2010年8月,本科收治的12例股骨干发生粉碎性骨折的患者临床资料,全部患者均予以MIPPO（经皮微创钢板固定）技术进行治疗,同时观察并分析患者治疗的临床效果。结果：12例患者X线检查均提示骨性愈合,并且均未出现深部的感染。结论：应用LISS,不仅创伤小,而且操作简便,更兼有固定可靠,以及并发症少等优点,为目前对股骨远端出现的骨折进行内固定治疗最有效的方法。     

MIPPO技术治疗闭合性胫腓骨骨折27例临床护理

目的:探讨经皮微创钢板内固定(MIPPO)技术治疗闭合性胫腓骨骨折的护理方法。方法:对我科收治并采用MIPPO技术治疗的27例闭合性胫腓骨骨折患者给予密切观察及护理,包括:积极的术前准备;术后观察切口情况、患肢运动、感觉、血运情况,从而判断有无神经、血管、肌腱损伤;指导患者早期适度功能锻炼,减少术后并发症,促进骨折愈合。结果:本组患者均康复出院,未发生术后大出血、感染等术后并发症;经6～21个月随访,所有患者患肢均活动良好,未发生关节僵硬;X线显示胫腓骨骨折愈合良好,未发生骨折不愈合、内固定物松脱、断裂等并发症。结论:密切及时的护理观察及正确早期的功能锻炼可以有效预防MIPPO技术在治疗闭合性胫腓骨骨折发生的术后并发症,促进患肢术后功能的早期恢复。