手法复位经皮微创锁定钢板固定治疗胫腓骨远端骨折60例

摘要

目的：探讨闭合手法整复经皮微创锁定钢板内固定治疗胫腓骨远端骨折的临床疗效。方法：自2009年至2011年采用闭合手法复位经皮微创锁定钢板内固定治疗60例胫腓骨远端骨折患者，其中男32例，女28例；年龄14～70岁，平均（41．22±2．06）岁。按AO骨折分型：A1型5例，A2型22例，A3型21例，C1型12例。术后观察并记录手术时间、术中出血量、骨痂出现时间、骨愈合时间，并采用Mazur踝关节评分系统对术后疗效进行评价。结果：术后Ⅰ期愈合58例，胫骨远端切口感染2例。手术时间45～90 min，平均（62．34±5．66） min；术中出血30～150 ml，平均（80．57±5．59） ml；X线片示骨痂出现时间4～12周，平均（8．24±2．06）周；骨愈合时间3～6个月，平均（4．50±1．13）个月。根据Mazur踝关节评分系统评价功能：优40例，良18例，中2例。结论：采用闭合手法整复经皮微创锁定钢板内固定治疗胫骨远端骨折，能更好地保护骨折部位的血供，同时取得更小微创切口条件下的可靠骨折固定，可获得满意的临床疗效，是治疗胫骨远端骨折的最佳选择之一。%Objective:To explore clinical effects of manipulative reduction with minimally invasive percutaneous plate osteosynthesis in treating distal tibiofibular fractures. Methods:From 2009 to 2011,60 patients with distal tibiofibular frac-tures were treated by manipulative reduction with minimally invasive percutaneous plate osteosynthesis. Among them ,there were 32 males and 28 females aged from 14 to 70 years old with an average of 41.22±2.06. According to AO classification of fractures,5 cases were type A1,22 cases were type A2,21 cases were type A3 and 12 cases were type C1. Operation time, blood loss,time of callus and fracture healing were observed,Mazur scoring of ankle joint were used to evaluate therapeutic. Results:Fifty eight incisions were healed at stageⅠ,and 2 cases were infected at distal tibial. Operation time was with an av-erage of (62.34±5.66) min ranged 45 to 90 min;blood loss was 30 to 150 ml with an average of (80.57±5.59) ml;formation of callus appeared from 4 to 12 weeks,with an average of (8.24 ± 2.06) weeks,and fracture healing time was from 3 to 6 months, with an average of (4.50±1.13) months. According to Mazur scoring of ankle joint,40 cases got excellent results,18 good,and 2 fair. Conclusion:Manipulative reduction with minimally invasive percutaneous plate osteosynthesis can obtain reliable fixa-tion. It is a good choice of treating distal tibiofibular fractures by protecting blood supply of fractures.