Minimally Invasive Plate Osteosynthesis in the Treatment of Complicated Fractures of the Tibia

微創鋼板固定手術治療複雜性脛骨骨折

王叔昂(Shu-Ang Wang)

《童綜合醫學雜誌》 6卷1期 (2012/06) Pp. 18-24

https://doi.org/10.29838/TMJ.201206.0003

摘要

比較利用微創鋼板固定手術與其他傳統開放式鋼板固定手術治療複雜性脛骨骨折的差異。本報告病人因為骨折處接近關節處或因為骨髓腔較小並不適用骨髓內釘固定，而採用不破壞到骨折處軟體組織的小傷口鋼板固定。這種手術方法，需在手術前先做好可接受的骨折處復位。本報告中所有病人的骨折處，在一年後均癒合。評估項目中所有病人的主觀感覺及膝關節活動都達到滿意程度。在疼痛的評估項目中，有三個病人因鋼板置放在脛骨內側造成該處皮膚緊繃而不舒適外，其他影響並不大。在本報告中，一個病人術後因不遵從使用輔助器的指示，造成鋼板變型，爾後又接受傳統民俗療法，而致感染。不過經過一次清創手術，待傷口穩定後重做鋼板固定手術，最後骨折處癒合。微創鋼板固定手術針對複雜性脛骨骨折有手術時間短、手術中出血少、感染機會少、住院時間短及良好的骨折癒合率的優點。

關鍵字

微創鋼板固定手術 ； 骨髓內釘 ； 複雜性脛骨骨折

並列摘要

A study of minimally invasive plate osteosynthesis (MIPO) in the treatment of 11 patients with comminuted fractures of the tibia compares to the conventional open plating in other studies. All were not allowed to have intramedullary nailing because of intra- or peri- articular fracture or smaller caliber of tibia. The MIPO techniques are by way of closed reduction before the operation and limited operative exposure without opening the fracture site. All cases went to union after one year of the operation. The evaluations of subjective feeling and joint motion both showed excellent recoveries. Three patients complained of skin tension because the plate was placed on the medial side of the tibia shaft. However, these patients were satisfied with their physical conditions. One case didn’t submit the initial non-weight bearing and had implant failure. Furthermore, she acted against medical advice to receive informal management and got infection as a result. Through one time of debridement, the fracture union was attained after later open reduction and plating.In conclusion, MIPO for these complicated tibia fractures has good bone union result, less operation time, less blood loss, shorter hospital stay, and no infection occurrence, compared with conventional open plating.

並列關鍵字

minimally invasive ； tibia ； osteosynthesis