Sah Shambhu, Bikash K C, Dangi Sailoj Jung, Rai Rem Kumar, Yadav Roshan
Department of Orthopedic, Koshi Zonal Hospital, Biratnagar, Nepal.
Department of Anesthesiology, Koshi Zonal Hospital, Biratnagar, Nepal.
JNMA J Nepal Med Assoc. 2017 Oct-Dec;56(208):456-60.
The management of distal tibia fracture is challenging because of the limited soft tissue coverage and poor vascularity around the bone in that area. Minimally invasive percutaneous plate osteosynthesis is a novel technique in this regard but needs fluoroscopy. In unavailability of fluoroscopy or its technical malfunction, limited open reduction percutaneous plate osteosynthesis becomes useful. The aim of this study is to compare the outcomes of distal tibia fractures treated by LORPPO and MIPPO techniques in terms of duration of hospital stay, full weight bearing, union time and complications.
Twenty-two cases of closed distal tibia fractures without articular involvement or comminution operated at Koshi Zonal Hospital, Nepal from March 2014 to May 2016 were included in this study. Total 11cases of which were treated by MIPPO whereas other 11 cases were treated by LORPPO. MIPPO technique was done only when the fluoroscopy was available.
In MIPPO, the average age of the patients were 43.72 (range 23-65) years, hospital stay mean duration 8.45 (range 6-12) days, full weight-bearing walking was started in 11.27 (range 9-15) weeks and average radiological union time was 21.25 (range 18-28) weeks. In LORPPO, the mean age was 46.36 (range 25-70)years, hospital stay mean 11.81 (range 10-15) days, full weight bearing walking mean 10.63 (range 9-15) weeks and average radiological union time was 23.0 (range 19-27) weeks.
The outcomes are comparatively similar for both the techniques. LORPPO could be an alternative to MIPPO in the management of distal tibia fractures.
由于胫骨远端骨折部位周围软组织覆盖有限且血运较差，其治疗颇具挑战性。微创经皮钢板接骨术是这方面的一项新技术，但需要使用透视设备。在无法进行透视或其出现技术故障时，有限切开复位经皮钢板接骨术就变得有用。本研究的目的是比较有限切开复位经皮钢板接骨术（LORPPO）和微创经皮钢板接骨术（MIPPO）治疗胫骨远端骨折在住院时间、完全负重、愈合时间及并发症方面的疗效。
纳入2014年3月至2016年5月在尼泊尔科希地区医院接受手术治疗的22例无关节受累或粉碎的闭合性胫骨远端骨折病例。其中11例采用MIPPO治疗，另外11例采用LORPPO治疗。仅在有透视设备时才进行MIPPO技术操作。
在MIPPO组中，患者的平均年龄为43.72岁（范围23 - 65岁），平均住院时间为8.45天（范围6 - 12天），11.27周（范围9 - 15周）开始完全负重行走，平均影像学愈合时间为21.25周（范围18 - 28周）。在LORPPO组中，平均年龄为46.36岁（范围25 - 70岁），平均住院时间为11.81天（范围10 - 15天），完全负重行走平均为10.63周（范围9 - 15周），平均影像学愈合时间为23.0周（范围19 - 27周）。
两种技术的疗效相对相似。在胫骨远端骨折的治疗中，LORPPO可作为MIPPO的替代方法。
