普通解剖钢板经皮微创内固定治疗胫骨远端粉碎性骨折

目的探讨普通解剖钢板（normal anatomical plate,NAP）微创经皮内固定（minimally invasive percutaneous plate osteosynthesis,MIPPO）治疗胫骨远端粉碎性骨折的临床疗效。方法2007年1月～2008年6月采用MIPPO技术,使用NAP内固定治疗18例胫骨远端骨折。均采用电透下间接复位技术和胫骨远端内侧钢板。结果手术切口长5.0～8.5cm,平均6.5cm;术中出血量60～300ml,平均145ml;手术时间30～120min,平均63min。2例开放性骨折术后发生小范围皮肤坏死,经换药后痊愈;无骨折不愈合、内固定失败、切口延迟愈合等并发症发生。18例术后随访4～10个月,平均8个月：术后4个月后骨折临床愈合,可弃拐负重行走。采用Johner-Wruhs评分标准：优11例,良7例。结论NAP结合MIPPO技术是治疗胫骨干远端骨折的理想方法之一,保护软组织,减少骨折端血供的破坏,促进骨折的愈合,减少并发症。

Percutaneous Fixation of Distal Tibia Comminuted Fracture by Using Normal Anatomical Plate

Objective To explore efficacy of minimally invasive percutaneous plate osteosynthesis （MIPPO） for the treatment of distal tibia comminuted fracture by using normal anatomical plate. Methods Between January 2007 and July 2008, 18 cases of distal tibia faeture were treated by MIPPO using anatomical plate. The clinical data of the patients were reviewed. Results A mean of 6.5 cm incision （5.0 -8.5cm） was made in the patients; the intraoperative blood loss ranged from 60 to 300 ml （mean, 145 ml） ; and the operation time ranged from 30 to 120 min with a mean of 63 min. After the surgery, 2 patients developed mild skin necrosis, and was then cured by conventional therapy; no patient had nonunion of the fracture, failure of internal fixation, or delayed wound healing. The 18 cases were followed up for a mean of 8 months （range, 4 to 10 months） ; all of them were healed clinically and could walk without crutch in 4 months postoperatively. According to Johner-Wruhs score system, 11 were excellent and 7 were good; the excellent-good rate was 100%. Conclusions MIPPO with anatomical plate is an optimal treatment for distal tibia eomminuted fracture with advantages in protecting the soft issues and bony blood supply, promoting the wound-healing process, and reducing the rate of complications.