微创经皮钢板内固定结合弹性髓内钉治疗成人胫腓骨远端骨折  

Minimally invasive percutaneous plate osteosynthesis and elastic nail system in the treatment of distal tibiofibular fracture in adults

作　　者：王磊[1] 祁荣[1] 李佳[1] 仇志学[1] 王凯[1] 索南昂秀[1] Wang Lei;Qi Rong;Li Jia;Qiu Zhixue;Wang Kai;Suo Nanangxiu(Department of Orthopedics,Qinghai Provincial People's Hospital,Xining 810007,Qinghai Province,China)

机构地区：[1]青海省人民医院骨科,青海省西宁市810007

出　　处：《中国组织工程研究》2021年第12期1864-1868,共5页Chinese Journal of Tissue Engineering Research

基　　金：青海省卫生健康委卫生计生科研课题(2017-wjzdx-05),项目负责人:索南昂秀。

摘　　要：背景:微创治疗胫腓骨远端骨折一直是临床的研究热点,闭合复位微创固定是真正意义上的微创,但存在长期随访的不足。目的:探讨微创经皮钢板内固定(minimally invasirepercutaneous plate osteosynthesis,MIPPO)结合弹性髓内钉治疗成人胫腓骨远端骨折的临床效果。方法:选择使用MIPPO技术结合弹性髓内钉内固定治疗成人胫腓骨远端骨折的患者25例,AO分型:A型18例,B型7例,C型0例。术后均进行对症治疗,并指导患者进行相应的下肢功能康复训练。术后1,3,6,12个月拍摄X射线片,根据骨折愈合情况决定负重时间。末次随访时分别采用Johner-Wruhs评分以及踝关节功能Phillips评分来评估踝关节功能。结果与结论:(1)术后随访15-28个月,所有患者术后8周开始拄双拐行下肢有限负重(10 kg);(2)AO分型A型患者骨折愈合时间较AO分型B型患者短,差异有显著性意义(P<0.05);(3)末次随访按照Johner-Wruhs标准,优21例,良4例;(4)术后末次随访根据Phillips评分评估踝关节功能,优19例,良4例,一般2例;其中末次随访AO分型A型患者Phillips评分总优良率为94%,AO分型B型患者为86%,差异有显著性意义(P<0.05);(5)所有患者均未出现切口问题或骨折端不愈合、内固定失败等并发症;(6)提示MIPPO结合弹性髓内钉治疗胫腓骨远端骨折具有愈合率高、功能恢复快等优点,符合创伤快速康复的原则理念,该方法在AO分型A型患者中更具优势。BACKGROUND:Minimally invasive treatment of distal tibiofibular fractures has always been a hot spot in clinical research.Closed reduction and minimally invasive fixation is a real minimally invasive treatment,but there are deficiencies in long-term follow-up.OBJECTIVE:To explore the efficacy of minimally invasive percutaneous plate osteosynthesis(MIPPO)technology and elastic nail system in the treatment of tibiofibular fracture in adults.METHODS:Twenty-five adult patients with distal tibiofibular fractures were treated with MIPPO technique combined with elastic intramedullary nailing.AO classification:There were 18 cases of type A,7 cases of type B,and 0 case of type C.All patients were given symptomatic treatment after operation,and the patients were instructed to carry out rehabilitation training of lower limb function.X-ray films were taken at 1,3,6,and 12 months after operation,and the weight-bearing time was determined according to the fracture healing.At the last follow-up,Johner-Wruhs score and Phillips score were used to evaluate ankle function.RESULTS AND CONCLUSION:(1)After 15-28 months of follow-up,all patients had limited weight bearing of lower limbs(10 kg)after 8 weeks of the operation.(2)The fracture healing time of AO type A patients was significantly shorter than that of AO type B patients(P<0.05).(3)According to Johner-Wruhs criteria at the last follow-up,21 cases were excellent and 4 cases were good.(4)The ankle joint function was evaluated according to the Phillips score at the last followup after operation.Totally 19 cases were excellent,4 cases were good,and 2 cases were average.Among them,the total excellent and good rate of Phillips score at the last follow-up was 94%in AO type A patients,and 86%in AO type B patients;the difference was significant(P<0.05).(5)There were no incision problems,nonunion of fracture ends,failure of internal fixation or other complications in all patients.(6)It is concluded that MIPPO technology and elastic nail system in the treatment of tibiofibular fracture ha

关 键 词：骨 胫骨 腓骨 骨折 内固定 钢板 弹性髓内钉 踝关节 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]