The Orthopaedic Center, the Affiliated Hospital of Guangdong Medical University, No. 57 South Renmin Avenue, Xiashan District, Zhanjiang, 524001, China.
The Operation Room, the Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
BMC Musculoskelet Disord. 2022 Dec 12;23(1):1081. doi: 10.1186/s12891-022-06008-y.
Minimally invasive plate osteosynthesis (MIPO) via percutaneous plate placement on the distal medial tibia can be performed with minimizes soft tissue injury and produces good clinical results. However, the difficulty with MIPO lies in how to achieve satisfactory fracture reduction and maintain that reduction via indirect reduction techniques to facilitate internal fixation. The purpose of this study was to compare the effects of AO distractor and manual traction reduction techniques combined with MIPO in the treatment of distal tibia fractures.
Between January 2013 and December 2019, 58 patients with a distal tibia fracture were treated using MIPO. Patients were divided into two groups according to the indirect reduction method that was used: 26 patients were reduced with manual traction(group M), and 32 were reduced with an AO distractor (group A).Time until union and clinical outcomes including AOFAS ankle-rating score and ankle range of ankle motion at final follow-up were compared. Mean operative time, incision length, blood loss and postoperative complications were recorded via chart review. Radiographic results at final follow-up were assessed for tibial angulation and shortening by a blinded reader.
Mean operative time, incision length, and blood loss in group A were significantly lower than in group M(p = 0.019, 0.018 and 0.016, respectively).Radiographic evidence of bony union was seen in all cases, and mean time until union was equivalent between the two groups (p = 0.384).Skin irritation was noted in one case(3.1%) in group A and three cases(11.5%)in group M, but the symptoms were not severe and the plate was removed after bony union. There was no statistically significant difference in postoperative complications between the two groups(p = 0.461). Mean AOFAS score and range of ankle motion were equivalent between the two groups, as were varus deformity, valgus deformity, anterior angulation and posterior angulation. No patients had gross angular deformity. Mean tibial shortening was not significantly different between the two groups, and no patients had tibial shortening > 10 mm.
Both an AO distractor and manual traction reduction techniques prior to MIPO in the treatment of distal tibial fractures permit a high fracture healing rate and satisfying functional outcomes with few wound healing complications. An AO distractor is an excellent indirect reduction method that may improve operative efficiency and reduce the risk of soft tissue injury.
经皮微创钢板接骨术（MIPO）通过在胫骨远端内侧经皮放置钢板，可以实现最小的软组织损伤，并获得良好的临床效果。然而，MIPO 的难点在于如何通过间接复位技术实现满意的骨折复位并维持复位，以方便内固定。本研究的目的是比较使用 AO 牵开器和手动牵引复位技术联合 MIPO 治疗胫骨远端骨折的效果。
2013 年 1 月至 2019 年 12 月，采用 MIPO 治疗 58 例胫骨远端骨折患者。根据使用的间接复位方法将患者分为两组：26 例采用手动牵引复位（组 M），32 例采用 AO 牵开器复位（组 A）。比较两组患者的愈合时间和临床结果，包括 AOFAS 踝关节评分和最终随访时的踝关节活动范围。通过图表回顾记录平均手术时间、切口长度、失血量和术后并发症。最终随访时的影像学结果由盲法读者评估胫骨成角和缩短情况。
组 A 的平均手术时间、切口长度和失血量明显低于组 M（p=0.019、0.018 和 0.016）。所有患者均有骨性愈合的影像学证据，两组的愈合时间相当（p=0.384）。组 A 有 1 例（3.1%）出现皮肤刺激，组 M 有 3 例（11.5%）出现皮肤刺激，但症状不严重，在骨性愈合后取出钢板。两组术后并发症发生率无统计学差异（p=0.461）。两组的 AOFAS 评分和踝关节活动范围相当，内翻畸形、外翻畸形、前倾角和后倾角也相当。没有患者出现明显的角度畸形。两组胫骨短缩差异无统计学意义，没有患者胫骨短缩>10mm。
在治疗胫骨远端骨折时，MIPO 术前使用 AO 牵开器和手动牵引复位技术均能获得较高的骨折愈合率和满意的功能结果，且伤口愈合并发症较少。AO 牵开器是一种优秀的间接复位方法，可提高手术效率，降低软组织损伤风险。
