胫骨远端爆裂骨折的微创治疗  

Micro-invasive Surgery of Splitting Distal Tibial Fracture

作　　者：黎早敏[1] 林坚平[1] 姚伦龙[1] 王书成[1] 郑南生[1] 曾凡[1] 

机构地区：[1]海南省人民医院创伤骨科,海口市570311

出　　处：《中国矫形外科杂志》2003年第11期749-750,共2页Orthopedic Journal of China

摘　　要：目的 :探讨胫骨远端爆裂骨折的直接微创外科治疗方法。方法 :腓骨骨折半管形钢板固定或透视复位 ,逆行克氏针髓内固定。小腿远端伤口扩创或胫前弧形切口 ,显露骨折并复位 ,有限的螺钉内固定 ,恢复肢体长度 ,维持小腿轴线 ,超踝关节双边三角形简易支架固定 ,干骺端骨缺损植骨。术后抗感染治疗 3～ 7d ,8～ 10周关节面骨折愈合后拆除固定踝关节的部分支架 ,踝关节功能锻炼 ,保留胫骨下段固定支架直至骨折全部愈合。结果 :随访 1～ 3年 ,按Bourne标准评估 :优良 45例 ,可 3例 ,差 1例 ,优良率 91.8%。结论 :直接微创外科技术治疗胫骨远端爆裂骨折能较好地克服钢板内固定存在的手术创伤大、难以控制的术后感染及由此诱发的骨折愈合障碍 ,是提高疗效的有效方法。Objective: To investigate direct micro invasive surgery of 49 cases splitting distal tibia fracture. Methods: In case of fibular fracture, fixation of half cast plate or retrograde Kirschner's wire fixation after reduction under fluoroscopy were recommended. If wound existed at the distal site of leg, we suggested debridement, exposure and reduction of fracture, limited screws fixation, recovered the length of limbs and axis of leg, double sides simple triangle trans articular external fixation and bone graft at metaphysis defects. Postoperative anti infection treatment persisted for 3～7 days. After 8～10 weeks, when the union of articular surface occurred, took out partial external fixation fixed ankle joint. The ankle began to exercise and kept the external fixation of inferior segment of tibia until union of fracture. Result:Forty nine cases were followed up for 1～3 years, according to the standard of Bourne, 45 cases were evaluated as excellent/good, 3 cases as fair, poor in 1 case. The excellent/good rate was 91.8%. Conclustion: Concerning splitting fracture of distal end of tibia, direct micro invasive surgery is an effective way that can better overcome the problems such as maximal operative trauma, uncontrollable postoperative infection and fracture non union, all of them may be induced by plate internal fixation.

关 键 词：胚骨 骨折 外科 微创 

分 类 号：R683.42[医药卫生—骨科学]