手法闭合复位结合MIPPO技术治疗胫骨骨折56例临床研究  

Close reduction combined with minimally invasive percutaneous plate osteosynthesis for proximal and distal tibial fractures:a report of 56 patients

作　　者：刘印文[1] 匡勇[1] 顾新丰[1] 郑昱新[1] 李志强[1] 卫晓恩[1] 张明才[1] 詹红生[1] 石印玉[1] 

机构地区：[1]上海中医药大学附属曙光医院石氏伤科医学中心,上海200021

出　　处：《中国骨伤》2013年第3期248-251,共4页China Journal of Orthopaedics and Traumatology

基　　金："中医骨伤科学"国家重点学科(编号:100508);上海领军人才项目(编号:041);上海市科委重点项目(编号:09dZ1973800);上海市卫生局中医药科研专项(编号:2010L018A);海派中医流派传承基地项目(编号:ZYSNXD-CC-HPGC-JD-001)~~

摘　　要：目的:观察手法闭合复位结合MIPPO技术治疗胫骨中上段、中下段骨折的临床效果。方法:2007年3月至2010年12月,治疗并获得随访的56例胫骨骨折,其中男39例,女17例;年龄22～67岁,平均41.3岁;左侧25例,右侧31例;34例为摔伤,22例为车祸伤;从受伤到手术时间平均1.7d;中上段15例,中下段41例;临床表现小腿疼痛肿胀,活动受限。采用手法闭合复位结合MIPPO技术治疗。术后采用Johner-Wruhs关节功能评定标准对疗效进行评定。结果:56例患者,手术操作时间平均46min,术后X线片示骨折复位满意,所有钢板螺钉位置良好;切口均Ⅰ期愈合,无表浅或深层感染。随访时间8～23个月,平均14.2个月;1例发生骨折延迟愈合,经自体髂骨植骨后骨折愈合,其余55例患者骨折在术后15～20周愈合,无固定失败;术后4～6个月均下地行走,7个月后行走无跛行,膝、踝关节功能与伤前一致且双下肢对称。按Johner-Wruhs关节功能评定标准,结果优46例,良9例,中1例。结论:手法闭合复位结合MIPPO技术治疗胫骨骨折,结合了传统正骨手法与现代骨科的优点,既保护了软组织,将手术程序简化、创伤降到最小,又能获得坚强的内固定,保证膝、踝关节的早期功能活动,具有软组织创伤小、血运破坏少、固定可靠等优点,是治疗胫骨近、远端骨折的一种有效方法,也符合微创生物学内固定观点。Objective ：To evaluate the clinical effects of close reduction combined with minimally invasive percutanous plate osteosynthesis （MIPPO） for proximal and distal tibial fractures. Methods：From March 2007 to December 2010,56 pa- tients with proximal and distal tibia] fractures were treated with close reduction combined with MIPPO technique. There were 39 males and 17 females, aged from 22 to 67 years with an average of 41.3 years. Left fracture was in 25 cases and right frac- ture was in 31 cases; proximal tibia] fracture was in 15 cases and distal tibia] fractures was in 41 cases;34 cases caused by fall down and 22 cases caused by road accident. The mean time from injury to operation was 1.7 d. Clinical manifestation included pain, swelling of leg with limitation of activity. According to the standard of Johner-Wruhs, clinical effects were evaluated. Re- stilts： The mean operative time was 46 rain in 56 patients. All fractures obtained satisfactory reduction and the location of plate was good. Incisions healed with one-stage and no superficial or deep infection was found. All the patients were followed up from 8 to 23 months with an average of 14.2 months. Only one fracture complcation with delayed union, and after auto grafting with ilium bone ,the fracture got union. Other 55 cases obtained bone healing in 15 to 20 weeks after operation and no internal fixa- tion failure was found. The time of walking was 4-6 months after operation,without limping at 7 months after operation. Both lower extremities were symmetrical and the function of knee and ankle got complete recovery. According to the criteria of John- er-Wruhs score ,46 cases obtained excellent results ,9 good and 2 fair. Conclusion ：Treatment of proximal and distal tibial fractures with close reduction and MIPPO technique can not only preserve soft tissue, simplify operative procedure and de- crease wound ,but also can obtain rigid internal fixation and guarantee early function exercises of knee and ankle joints. The method has the advantages o

关 键 词：胫骨骨折 闭合复位 外科手术 微创性 

分 类 号：R683.41[医药卫生—骨科学]