胫骨牵引架在股骨远端骨折经皮微创钢板内固定中的应用

摘要

目的 使用胫骨骨折闭合复位牵引架进行股骨远端骨折闭合复位、经皮微创锁定钢板内固定(minimally invasive percutaneous plate osteosynthesis,MIPPO),并评价其临床应用效果.方法 收集2014年4月至2016年3月于我院利用胫骨骨折闭合复位牵引架闭合复位26例股骨远端骨折患者资料,其中男18例,女8例,年龄25～76岁,平均年龄(50±10.1)岁.骨折按照AO分型:A型19例,C型7例;受伤至手术时间2～14 d,平均(5.6±3.1)d.所有患者均先利用胫骨骨折闭合复位牵引架,进行骨折端闭合复位,然后再行MIPPO手术治疗.测量手术前、后骨折端成角及移位情况,记录术中骨折闭合复位透视次数及手术时间.术后1年根据Schatzker-Lambert标准评定患肢功能.结果 本组26例患者均利用胫骨骨折闭合复位手术架,顺利完成了骨折端的闭合复位.术前股骨远端正位片显示骨折端向内或向外成角0～16°,平均成角8.0°±3.1°,股骨远端侧位片显示向后成角5°～38.6°,平均成角为16.8°±8.4°.术后股骨远端正位片显示向内或向外成角0～3.2°,平均成角1.8°±0.6°,股骨远端侧位片显示向后成角0～3.8°,平均成角2.5°±0.6°.术中闭合复位骨折透视次数3～9次,平均(6.0±1.2)次;手术时间80～120 min,平均(100±11.6) min.术中、术后均无相应的血管、神经症状产生,创面均一期愈合.术后25例患者获得随访,随访时间12～28个月,平均(18±3.9)个月.骨折端延迟愈合1例、不愈合1例,其余患者骨痂形成时间3～6个月,平均(4±0.7)个月.术后1年,按照Schatzker-Lambert标准评定患肢功能:优22例,良3例,优良率100％.结论 胫骨骨折闭合复位牵引架结构简单、操作方便,运用在股骨远端骨折MIPPO手术时,可有效完成骨折端的闭合复位,临床应用效果理想.%Objective To introduce an indirect reduction technique using a modified tibial distraction support in minimally invasive percutaneous plate osteosynthesis (MIPPO) of distal femur fractures and investigate its clinical effect.Methods Between April 2014 and March 2016,26 distal femur fractures treated with MIPPO technique using a modified tibial distractionsupport were reviewed.There were 18 males and 8 females with an average age of (50±10.1) years (25-76 years).Among them,nineteen patients were type A and 7 patients were type C according to AO classification.Operations were performed on an average of (5.6±3.1) d (2-14 d) after the trauma.All the patients were performed indirect reduction with a modified tibial distraction support before using the MIPPO technique.Angular deformity was obtained from preoperative and postoperative for all subjects.In each case,intraoperative image intensification shots to confirm reduction and the operating time were recorded.Functional outcome was evaluated using the Schatzker-Lambert criteria 1 year postoperative.Results All the patients completed closed reduction using the modified tibia] distraction support.Preoperative anteroposterior radiographs revealed amean of 8.0°±3.1° (0-16°) angulation in the coronal plane.Lateral radiographs revealed a mean of 16.8°±8.4° (5°-8.6°) angulation in the sagittal plane.Postoperative anteroposterior and lateral radiographs showed a mean angulation of 1.8°±0.6° (0-3.2°) and 2.5°±0.6° (0-3.8°) of varus/valgus and apex posterior angulation,respectively.The mean operating time was (100±11.6) min (80-120 min).No intraoperative or postoperative complications were encountered.Twenty-five patients were followed up and the mean follow up time was (18±3.9) months (12-28 months).There were one delayed union and one non-union.The average time of radiographic evidence of bridging callous was present at (4±0.7) months (3-6 months) in the remained patients.There were 22 excellent patients and 3 good patients according to Schatzker-Lambert criteria one year postoperative.The excellent rate was 100％.Conclusion The modified tibial distraction support is simple and easy to manipulate which is a good option in MIPPO for distal femur fractures and has good clinical effects.