Application of minimally invasive locking compression plate in treatment of distal tibia fractures

Abstract

OBJECTIVE: To evaluate the application of minimally invasive plate osteosynthesis (MIPO) technique in treatment of distal tibia fractures with locking compression plate (LCP). METHODS: From August 2002 to August 2007, 62 subjects were recruited (36 males and 26 females) at mean age of 44 years old (range, 21-87 years old). According to AO classification, there were 8 cases of type A1, 15 cases of type A2, 9 cases of type A3, 7 cases of type B3, 11 cases of type C1, and 12 cases of type C2. Of them, 52 patients had closed fractures and 10 had open fractures. Ten open fractures included 6 Grade I fracture and 4 Grade II fracture. The time from injury to operation was 8 hours to 6 days. The X-ray films were taken after 3 months of operation. RESULTS: Near anatomical reduction was achieved in 56 fractures and acceptable reduction in 6 fractures. Mean operation time was 43 minutes (range, 37-120 minutes). Primary healing of surgical wounds was observed in all cases. Subjects were followed up for 23 months on average (ranged, 18-45 months). All fractures healed with a mean healing time of 19.5 weeks (range, 16-32 weeks). According to Teens and Wiss ankle scoring system, 30 patients got excellent results, 25 good, and 7 fair; and the excellent and good rate was 88.7% at 12-month follow-up. There were 7 cases of delayed soft tissue infection which needed implant removal. There was one complication of compartment syndrome which required fasciotomy. There was one case with loss of reduction (valgus tilting of tibial plafond) that required bone grafting. CONCLUSION: The results of MIPO LCP in treatment of distal tibia fractures were satisfactory. This technique was safe with no incidence of serious complications.

目的探討采用微創接骨板固定(minimally invasive plate osteosynthesis,MIPO)技術植入鎖定加壓鋼板(locking compression plate,LCP)治療脛骨遠端骨折的臨床效果。方法2002年8月-2007年8月,采用MIPO技術植入LCP治療62例脛骨遠端骨折患者。其中男36例,女26例;年齡21～87歲,平均44歲。均為脛骨遠端新鮮骨折。骨折根據AO分型,A1型8例,A2型15例,A3型9例,B3型7例,C1型11例,C2型12例。開放骨折10例,GradeⅠ型6例,Ⅱ型4例;閉合骨折52例。創傷指數為4～24,平均12.6。受傷至手術時間8h～6d。術后3個月每月復查X線片,術后6、12個月定期隨訪,骨折牢固愈合、拆除鋼板后再隨訪6個月。結果術中56例獲接近解剖復位,6例僅達可接受復位。手術時間37～120min,平均43min。術后切口均Ⅰ期愈合。62例均獲隨訪,隨訪時間18～45個月,平均23個月。X線片示骨折均達骨性愈合,愈合時間16～32周,平均19.5周。41例于術后15～24個月拆除鋼板,平均16個月。術后12個月按Teeny等踝關節功能評分標準評價,獲優30例,良25例,可7例,優良率88.7%。7例發生延遲軟組織感染,拆除內固定后功能恢復良好;1例發生小腿骨筋膜室綜合征,行筋膜室切開減壓;1例術后6個月脛骨遠端腓側關節面發生塌陷,拆除內固定并植骨后愈合良好。結論采用MIPO技術植入LCP治療脛骨遠端骨折可獲滿意效果,無嚴重并發癥發生。