外固定架辅助复位结合微创钢板置入内固定修复复杂性胫腓骨粉碎性骨折

背景：高能量的胫腓骨粉碎性骨折常合并软组织损伤,若在内固定过程中复位方法不当可造成软组织的二次损伤;寻找种既能达到稳定的内固定,又尽量避免加重软组织损伤的方法是骨科医生研究的目标。目的：观察应用临时外固定支架辅助复位结合微创钢板置入修复复杂性胫腓骨粉碎性骨折的临床疗效。方法：广州医学院附属广州市第一人民医院自2008-02/2010-03收治的复杂胫腓骨粉碎性骨折患者39例,在行微创内定的同时采用临时外固定支架术中辅助复位,内固定安放牢固后拆除临时外固定。结果与结论：39例均获得随访,随访时间6～18个月。手术平均时间75min,其中36例患者内固定后患肢肿胀程度轻手术切口一期甲级愈合,2例患者伤口边缘水肿,结痂后瘢痕愈合,1例内固定后3个月出现急性骨髓炎,经保守抗炎治后恢复。未出现钉道感染、螺钉松动及切口感染、皮肤坏死、露骨露腱病例,依据AOFAS踝关节评分法,钢板置入半后踝关节恢复情况：优29例,良8例,一般2例。踝关节屈伸活动范围≥30°29例,20°～30°8例,20°以下2例。

External fixation combined with minimally invasive plate fixation for complex tibial and fibular fracture

BACKGROUND：High-energy comminuted fracture of tibia and fibula is often associated with soft tissue injury,the improper reduction method during the operative process of internal fixation can cause secondary soft tissue damage,resulting in serious consequences such as：skin infection and necrosis,bone exposure,osteomyelitis,bone defects and others;Looking for a way both to achieve stable internal fixation,and avoid aggravated soft tissue damage is the object of study for orthopaedic surgeon.OBJECTIVE：To investigate the clinical therapeutic effect of external fixation combined with MIPO technology used in complex tibial and fibular fracture.METHODS：Retrospective analysis was used in 39 cases of complex comminuted fracture of tibia and fibula selected from Guangzhou First People＇s Hospital Affiliated to Guangzhou Medical College.In the minimally invasive internal fixation surgery,the temporary external fixation assisted reduction technology combined with MIPO technology used in all cases,and be removed after internal fixed firmly.RESULTS AND CONCLUSION：All the 39 patients were followed up covering a period from 6 to 18 months with an average of 12 months.Results show the osteological healing of 36 cases reached grade A primary intention healing with slightly affected limb swelling;2 cases of wound edge swelling,healing by scar;1 case of acute osteomyelitis in 3 months,healing after conservative anti-inflammatory therapy;none appeared operatively fixator nail hole infection,screw loosening and incision infection,skin necrosis,exposed bones and tendons.According to AOFAS ankle score,at 6 months after plate implantation,the ankle joint recovery condition was as follows：excellent in 29 cases,good in 8 cases,fair in 2.Range of ankle flexion and extension was ≥ 30° in 29 cases,20° to 30° in 8 cases,and 20° or less in 2 cases.