胫骨后外侧入路Mipo术式在合并前方软组织损伤Gustilo Ⅲ型胫骨骨折的应用观察  

Application of Minimally Invasive Plate Osteosynthesis(Mipo)with posterolateral tibial approach in Gustilo typeⅢtibial fracture with anterior soft tissue injury

作　　者：袁路程 年争好 吴奎 卢山 李强[1] Yuan Lu-cheng;Nian Zheng-hao;Wu Kui;Lu Shan;Li Qiang(Department of Orthopedics,Suzhou First People’s Hospital,Suzhou 234000,China;Department of Orthopedics,Suzhou Municipal Hospital of Anhui Province,Suzhou 234000,China)

机构地区：[1]宿州市第一人民医院骨科,宿州234000 [2]安徽省宿州市立医院骨科,宿州234000

出　　处：《湖南师范大学学报（医学版）》2021年第2期232-236,共5页Journal of Hunan Normal University(Medical Sciences)

摘　　要：目的:随访胫骨后外侧入路Mipo技术在合并小腿前方软组织损伤的Gustilo Ⅲ型开放性胫骨中下段骨折的临床结局。方法:我院从2016年1月~2019年12月期间,共有28名Gustilo Ⅲ型开放性胫骨中下段骨折患者接受了胫骨后外侧入路Mipo手术,并按要求完成随访。其治疗方案采用分期综合治疗,包括早期的伤口清创、软组织修复、骨折外固定,以及最终的胫骨骨折Mipo手术。本研究以Gustilo ⅢA型、Gustilo ⅢB型骨折分型为分组依据,采用骨折愈合时间、AOFAS足踝功能评分、并发症发生情况为观察指标。结果:两组患者平均随访时间分别为16.29、17.09月。全部患者都获得骨折愈合,平均骨折愈合时间前者为23.76周,后者为27.18周。末次随访时点AOFAS评分在Gustilo ⅢA型患者平均为91.35分,在Gustilo ⅢB型骨折平均为92.36分。未观察到骨感染、切口不愈合等相关并发症。结论:胫骨后外侧入路Mipo手术是合并前方软组织损伤的开放性胫骨骨折患者的适用术式。Objective To evalute the clinical outcomes of Gustilo type Ⅲ open tibial shaft fractures with anterior and medial soft-tissue injuries,treated with posterolateral minimally invasive plate osteosynthesis(MIPO)procedure.Methods From January 2016 to December 2019,28 patients with Gustilo type Ⅲ open tibial shaft fractures with anterior and medial soft-tissue injuries(Gustilo-Anderson classification ⅢA,19;ⅢB,9)were treated with staged protocol using posterolateral minimally invasive plate osteosynthesis(MIPO)technique.The initial wound lavage,debridement,and application of an external fixator were performed at admission and the mean interval from injury to definitive osteosynthesis treatment was 14.94 and 16 days for Gustilo ⅢA and ⅢB groups respectively.Postoperative radiographs,postoperative complications,bone union,and limb functional outcome information of AOFAS ankle-hindfoot score were recorded.Results The mean follow-up duration was 16.29 and 17.09 months respectively.Bone union was achieved in all cases and the mean interval to bony union in each group was 23.76 and 27.18 weeks.The average AOFAS score of each group was 91.35 and 92.36.There were no complications,such as incision breakdown,deep infection.Conclusion Staged treatment using MIPO technique through a posterolateral approach is a treatment option for open tibial shaft fractures,especially Gustilo type Ⅲ with severe anterior and medial soft-tissue injuries.

关 键 词：GustiloⅢ型 开放性胫骨骨折 胫骨后外侧入路 MIPO 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学] R687[医药卫生—基础医学]