Gupta P, Tiwari A, Thora A, Gandhi J K, Jog V P
Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India.
Malays Orthop J. 2016 Mar;10(1):29-37. doi: 10.5704/MOJ.1603.006.
The treatment of fractures of proximal and distal tibia is challenging, because of the limited soft tissue envelope and poor vascularity. The best treatment remains controversial and it depends on the fracture morphology, displacement and comminution. Treatment options vary from closed reduction and cast to open reduction and internal fixation with plate. Open reduction and internal fixation with plate can result in extensive dissection and tissue devitalization. We conducted a study on management of these fractures by biological osteosynthesis using Minimally Invasive Plate Osteosynthesis (MIPO) technique with preservation of osseous and soft tissue vascularity. We conducted a prospective study on closed reduction and percutaneous plating in 30 cases (mean age 42.7 years; 22 males and 8 females) of closed fractures of tibia. Among them 24 had proximal tibial fractures and 6 had distal tibial fractures. The mean time from injury to surgery was seven days. The mean operative time was 72.6 minutes ( range: 55-90 minutes). Mean time for radiological union was 17 weeks (range: 14-22 weeks). There was one superficial wound infection which resolved with daily dressings and one week of oral antibiotics. One patient developed a nonunion which required a bone grafting procedure. The satisfactory functional results and lack of soft tissue complications suggest that this method should be considered in periarticular fractures. Biological fixation of complex fractures gives stable as well as optimal internal fixation and complete recovery of limb function at an early stage with minimal risk of complications.
由于胫骨近端和远端骨折部位软组织覆盖有限且血供较差，其治疗颇具挑战性。最佳治疗方法仍存在争议，这取决于骨折的形态、移位情况和粉碎程度。治疗选择从闭合复位石膏固定到切开复位钢板内固定不等。切开复位钢板内固定可能导致广泛的组织剥离和组织失活。我们采用微创钢板接骨术（MIPO）技术并保留骨和软组织血供，对这些骨折的生物学接骨治疗进行了研究。我们对30例闭合性胫骨骨折患者（平均年龄42.7岁；男性22例，女性8例）进行了闭合复位经皮钢板固定的前瞻性研究。其中24例为胫骨近端骨折，6例为胫骨远端骨折。受伤至手术的平均时间为7天。平均手术时间为72.6分钟（范围：55 - 90分钟）。影像学骨愈合的平均时间为17周（范围：14 - 22周）。有1例表浅伤口感染，经每日换药及口服一周抗生素后痊愈。1例患者发生骨不连，需要进行植骨手术。满意的功能结果以及缺乏软组织并发症表明，对于关节周围骨折应考虑采用这种方法。复杂骨折的生物学固定能提供稳定且最佳的内固定，并在早期使肢体功能完全恢复，并发症风险最小。
