Helfet D L, Shonnard P Y, Levine D, Borrelli J
Orthopaedic Trauma Service, Hospital for Special Surgery, New York, NY 10021, USA.
Injury. 1997;28 Suppl 1:A42-7; discussion A47-8. doi: 10.1016/s0020-1383(97)90114-5.
Minimally invasive plate osteosynthesis of distal tibial fractures is technically feasible and may be advantageous in that it minimizes soft tissue compromise and devascularization of the fracture fragments. The technique involves open reduction and internal fixation of the associated fibular fracture when present, followed by temporary external fixation of the tibia until swelling has resolved. Subsequent limited, but open reduction and internal fixation of the articular fragments when displaced followed by minimally invasive plate osteosynthesis of the tibia utilizing precontoured tubular plates and percutaneously placed cortical screws is performed. The semitubular plate was chosen because it adapts more easily to the bone contours than the stiffer small fragment LC-DCP does. Twenty patients (age 25-59 years) with unstable intraarticular or open extraarticular fractures have been treated including 12 A-type, 1 B-type and 7 C-type fractures according to the AO classification. Two fractures were open (both Gustilo Type I). Closed soft tissue injury was graded according to Tscherne with 3 type C0, 7 type C1, 7 type C2 and 1 type C3. All fractures healed without the need for a second operation. Time to full weight-bearing averaged 10.7 weeks (range 8-16 weeks). Two fractures healed with > 5 degrees varus alignment and 2 fractures healed with > 10 degrees recurvatum. No patient had a deep infection. The average range of motion in the ankle for dorsiflexion was 14 degrees (range 0-30 degrees) and plantar flexion averaged 42 degrees (range 20-50 degrees). With longer follow-up and a larger number of patients, the authors feel confident that the minimally invasive technique for plate osteosynthesis for the treatment of distal tibial fractures will prove to be a feasible and worthwhile method of stabilization while avoiding the severe complications associated with the more standard methods of internal or external fixation of those fractures.
胫骨远端骨折的微创钢板接骨术在技术上是可行的，其优势在于能将软组织损伤和骨折碎片的血运破坏降至最低。该技术包括对存在的相关腓骨骨折进行切开复位内固定，随后对胫骨进行临时外固定，直至肿胀消退。当关节面骨折块移位时，先进行有限切开复位内固定，然后使用预塑形的管状钢板和经皮置入的皮质骨螺钉对胫骨进行微创钢板接骨术。选择半管状钢板是因为它比更硬的小切口动力加压钢板（LC-DCP）更容易贴合骨轮廓。已治疗20例（年龄25 - 59岁）不稳定的关节内或开放性关节外骨折患者，根据AO分类，其中包括12例A型、1例B型和7例C型骨折。2例骨折为开放性（均为Gustilo I型）。闭合性软组织损伤根据Tscherne分级，C0型3例，C1型7例，C2型7例，C3型1例。所有骨折均愈合，无需二次手术。完全负重的平均时间为10.7周（范围8 - 16周）。2例骨折愈合时内翻畸形大于5度，2例骨折愈合时后凸畸形大于10度。无患者发生深部感染。踝关节背屈的平均活动范围为14度（范围0 - 30度），跖屈平均为42度（范围20 - 50度）。随着随访时间延长和患者数量增加，作者相信用于治疗胫骨远端骨折的微创钢板接骨术将被证明是一种可行且有价值的稳定方法，同时可避免与那些骨折更标准的内固定或外固定方法相关的严重并发症。
