Liu Yin-Wen, Zheng Yu-Xin, Wang Xue-Zong, Zhang Hu, Sun Mu-Zheng, Kuang Yong, Zhang Lei, Shen Zi-Liang, Zhan Hong-Sheng, Shi Yin-Yu
Zhongguo Gu Shang. 2015 Mar;28(3):230-4.
To compare the effects of close reduction combined with minimally invasive percutaneous plate osteosynthesis for distal fracture of tibial shaft.
From March 2009 to May 2013, there were 124 patients (89 males and 35 females, 30 of them were injured in a traffic accident and 94 were falling down in daily life, the ages ranging from 21 to 81 years old) who suffered from distal fracture of tibial shaft. Sixty-six patients (48 males and 18 females, 45 cases of type A, 12 cases of type B and 9 cases of type C) were treated with close manipulative reduction combined with minimally invasive percutaneous plate fixation. After close reduction, a minimal incision was made and a anatomic plate was inserted just along the medial tibia periostea, and then the fracture was fixed without fracture exposure. The other 58 patients (41 males and 17 females, 41 cases of type A, 10 cases of type B and 7 cases of type C) were treated with conventional open reduction and internal fixation. Length of the incision, operating time, early postoperative pain (recorded using the Visual Analog Scale score) and the outcome results (recorded using the evaluation standard of Johner-Wruhs) were compared.
The length of incision was meanly (7.34 ± 1.42) cm in MIPPO group and (21.82 ± 2.35) cm in ORIF group; operation time was (44.48 ± 10.00) min in MIPPO group and (59.42 ± 11.84) min in ORIF group. The postoperative radiographs verified good position of all screws and satisfactory bone fracture reduction in both groups. All the patients were followed up, and the duration ranged from 10 to 24 months (mean 15.2 months) in both groups. In MIPPO group,only one patient had delayed union and got union after Chinese herb therapy. The other 65 patients got bony union during 15 to 20 weeks. While in ORIF group, 3 patients suffered from nonunion and received reoperation with bone grafting, and 4 patients got bone infection.
Treatment of distal fracture of tibial shaft, combined with close reduction and MIPPO technique, has the advantages such as less invasion, less damage of blood supply, simplified procedure of operation and higher union rate, which is an ideal methods and is accordant to the biological demand.
比较闭合复位联合微创经皮钢板内固定术治疗胫骨干下段骨折的效果。
选取2009年3月至2013年5月收治的124例胫骨干下段骨折患者（男89例，女35例，交通事故伤30例，日常生活摔伤94例，年龄21～81岁）。其中66例患者（男48例，女18例，A型45例，B型12例，C型9例）采用闭合手法复位联合微创经皮钢板内固定治疗。闭合复位后，沿胫骨内侧骨膜做小切口，插入解剖钢板，不暴露骨折部位直接固定骨折。另外58例患者（男41例，女17例，A型41例，B型10例，C型7例）采用传统切开复位内固定治疗。比较两组手术切口长度、手术时间、术后早期疼痛情况（采用视觉模拟评分法记录）及疗效结果（采用Johner-Wruhs评价标准记录）。
微创经皮钢板内固定组手术切口长度平均为（7.34±1.42）cm，切开复位内固定组为（21.82±2.35）cm；微创经皮钢板内固定组手术时间为（44.48±10.00）min，切开复位内固定组为（59.42±11.84）min。术后X线片显示两组螺钉位置良好，骨折复位满意。两组患者均获随访，随访时间10～24个月，平均15.2个月。微创经皮钢板内固定组仅1例患者出现延迟愈合，经中药治疗后愈合。其余65例患者于15～20周获得骨性愈合。切开复位内固定组有3例患者出现骨不连，行二次手术植骨治疗，4例患者发生骨感染。
闭合复位联合微创经皮钢板内固定术治疗胫骨干下段骨折具有创伤小、血供破坏少、手术操作简单、愈合率高等优点，是符合生物学要求的理想治疗方法。
