锁定加压钢板结合微创经皮钢板内固定技术治疗Pilon骨折

目的：总结使用锁定加压钢板（locked compression plate,LCP）结合微创经皮钢板内固定技术（minimally invasive percutaneous plate osteosynthesis,MIPPO）治疗胫骨Pilon骨折的临床疗效.方法：回顾总结自2009年1月至2012年12月采用MIPPO结合LCP内固定治疗的Pilon骨折.排除开放性骨折、病理性骨折、患肢有血管疾病和患肢神经损伤的病例,共纳入38例,其中男29例,女9例;平均年龄48岁（21～78岁）.骨折按AO分型：B型20例,C型18例.根据手术时间、术中出血量、复位质量、骨折愈合时间、并发症、术后踝关节功能等对疗效进行评定,并参照美国足与踝关节协会（American Orthopaedic Foot and Ankle Society,AOFAS）踝与后足主观评分标准评定疗效.结果：38例均获随访,平均随访时间18个月（13～24个月）.骨折全部获得骨性愈合,无钢板断裂及复位固定失败,1例伤口浅表感染,经使用抗生素及换药后治愈.术后AOFAS评分65 ～97分,平均（81.0±4.5）分.结论：MIPPO结合LCP治疗胫骨Pilon骨折,创伤小,并发症少,功能恢复满意.

Locking compression plate (LCP) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) for the treatment of Pilon fracture

Objective: To summarize clinical outcomes of locking compression plate (LCP) combined with minimally invasive percutaneous plate osteosynthesis (MIPPO) for the treatment of Pilon fracture.Methods: From January 2009 to December 2012,Pilon fracture patients treated by LCP with MIPPO were retrospectively analyzed. All open fractures,pathologic fractures and those who had limb vascular disease or nerve injury were excluded. Thirty-eight patients were enrolled,including 29 males and 9 females aged from 21 to 78 years old with an average of 48 years old. According to AO classification,20 cases were type B,18 cases were type C. Operative time,blood loss,reduction quality,time of fracture healing complications and postoperative ankle joint function were applied for evaluating clinical outcomes,AOFAS scoring were used for assessing postoperative clinical effects.Results: All patients were followed up from 13 to 24 months(averaged 18 months). All patients obtained bone union without any plate failures or loss of fixation/reduction. One patient occurred superficial wound infection,and resolved with antibiotics and local wound care. Postoperative average AOFAS score was 81(ranged 65 to 97).Conclusion: LCP with MIPPO for Pilon fratcure has advantages of less invasion,fewer complications and satisfactory ankle function.