加压锁定接骨板在治疗小腿中下1/3骨折中的应用

目的回顾总结应用微创接骨板固定术（MIPO）以锁定加压接骨板（LCP）治疗小腿中下1/3骨折的经验。方法 2007年1月至2010年10月应用MIPO技术以LCP桥式固定方式治疗小腿中下1/3骨折71例,男49例,女22例,平均年龄45.7岁（21～72岁）。伤后至手术时间平均8.9d（6～21d）,骨折以AO分型：A1型5例,A2型21例,A3型45例,复位后胫骨71例以MIPO技术置入LCP桥式固定,49例腓骨切开复位解剖型或重建锁定接骨板内固定。术后1、2、3、6个月复查,分别进行临床查体,X线片评估及康复指导,骨折愈合后患者踝关节功能以Lowa评分系统评分。结果平均手术时间87.5min（62～175min）,平均失血量56ml（35～170ml）,胫骨骨折端至少旷置3个钉孔,螺钉密度平均0.62（0.50～0.71）,平均置入螺钉9.5枚（7～15枚）,LCP长度225mm（157.6～243.5mm）,平均随访时间13.1个月（4～29个月）,平均愈合时间3.8个月。所有患者无接骨板、螺钉松动断裂,骨折愈合后x线片显示下肢力线无成角及旋转,下肢无短缩,膝、踝关节面无倾斜,1例切口皮肤坏死经旋转皮瓣修复后愈合,Lowa踝关节评分平均92.5分,优52例,良16例,中3例,优良率96.8%。结论应用MIPO技术以LCP桥式固定治疗小腿中下1/3骨折是一种有效保持骨折断端血运,符合弹性固定理念并能促进骨折愈合的新技术。

Locking compression plate in the treatment of the lower third of leg fractures

Objective To summarize the minimally invasive plate fixation with locking compression plate（LCP） treatment of the lower third of leg fractures.Methods From January 2007 to October 2010 application MIPO technology to bridge fixations LCP one-third of middle and lower leg fractures of 71 cases of fracture.49 males and 22 females.The average age of 45.7（21 -72 years）.The average time from injury to surgery 9.2 days（6 -21 ）.Al type 5 cases,A2 type 21 case,A3 type 45 cases,reduction of the tibia in 71 cases to MIPO technology into LCP bridge fixed,49 cases of fibula open reduction and anatomical or reconstruction locking plate fixation.On review after 1,2,3,6months respectively clinical physical examination,X-ray assessment and rehabilitation guidance,patients with ankle fracture healing function to Lowa scoring system.Results The mean operative time was 87.5 min（62-175 min）,the average blood loss was 56ml（35 - 170ml）,Tibial fracture at least 3 vacant nail holes,screw the average density of 0.62（0.50 -0.71） The average screw insertion 9.5（7 - 15）,LCP length 225mm（157.6 - 243.5mm）,the average follow-up time of 13.1 months（4-29 months）,the average healing time of 3.8 months.All patients had no plate.Screw loosening or breakage, fracture healing after x-ray film showed no angular limb alignment and rotation,no shortening of lower limbs,knees.Ankle joint,no tilt,one case of skin necrosis incision healed after skin flap rotation.Lowa ankle score was 92.5 hours,52 cases of excellent and good in 16 cases and in 3 cases and good rate was 96.8%.Conclusion MIPO LCP bridge technology to lower the fixed treatment of one-third of middle and lower leg fractures is an effective blood supply to maintain end segment fractures,consistent with elastic fixed ideas and promote new techniques of fracture healing.