A Clinical Study Of Minimally Invasive Percutaneous Plate Osteosynthesis(MIPPO) Treatment To Proximaltibial Fractures

Objectives:To investigate the curative effect, surgical indications and relevant operation points of minimally invasive percutaneous plate osteosy-nthesis (MIPPO) treatment to proximal tibial fractures.Methods:28 patients received internal fixation with MIPPO tech-nology and traditional fixation for proximal tibial fractures in recent years in our hospital were investigated, and have been followed up for 6 to 12 months to collect clinical data.19 cases were male,9 females, aged 23 to 58 years, mean 38 years. According to Schatzker classification,8 cases of them were classified as typeⅠ,5 as typeⅡ,7 as typeⅢ,3 as typeⅣ,3 as typeⅤ, and 2 cases as typeⅥ.2 cases of them were complicated with moderate head injury,1 with rib fracture, and 2 cases with distal femoral fractures. Among the 28 patients,11 cases were treated with traditional open reduction and internal fixation, while 17 cases received MIPPO technology fixation. And all of them were investigated to get data from afteroperation to final follow-up. Evaluate the clinical results according to Johner-Wruhs evaluation method, and analyze the statistical significances using the SPSS version 13.0 software (SPSS Inc., USA). P value less than 0.05 was considered as statistically significant.Results:1.The patients were followed up for 6 to 12 months by telephone or out patient clinic (with an average of 8.9 months).25 cases received regular follow-up in this investigation, but 3 cases couldn't receive terminal follow-up for lack of out clinic review or contact change after discharge. 2.According to Johner-Wruhs evaluation method,10 cases were assessed to be excellent during postoperative functional recovery period in MIPPO group, good in 6 cases, can be and poor in 0 case respectively. The excellent rate is 95.6%. On the other hand,6 cases were assessed to be excellent during postoperative functional recovery period in traditional fixation group, good in 2 cases, can be in 1 case and poor in 0 case. The excellent rate is 83.2%.3.The statistical analysis results by SPSS 13.0 version software are as follows:①Time-consuming in MIPPO group is 0.4h longer than conventional open surgery group, but there is no significant difference between two groups (P>0.05).②Blood loss in MIPPO group was 180ml (mean 150ml), Postoperative fever for 3～4 days (mean 3.2days), and hospitalization days for 6～14days (mean 8.5days). All the data were significantly lower than the traditional incision group (P<0.05).③Healing time in MIPPO group is from 9 to 16 weeks (mean 11.7 weeks), and showed no significant compared with the traditional incision group (P> 0.05).④Full load time in MIPPO group is from 11 to 19 weeks (mean 14.5 weeks), the difference was significant (P<0.05).⑤There were 3 cases suffered from delayed union and 1 case suffered from nonunion in traditional incision group. On the other hand, there were only 1 cases suffered from delayed union in MIPPO group, and all the incision healed with no wound infection.Conclusions:MIPPO technology in the treatment of proximal tibial fractures with the feature of less soft tissue dissection and consistent with the biological fixation, has the advantage of solid fixation, small incision and functional reduction of minimally invasive techniques, and reduces the incidence of postoperative complications after open reduction and internal fixation. Meanwhile, MIPPO technology, as a new fracture technique, maintains the stability of the bone, meets the beautiful incision line and BO idea, and achieves the biological-psychological-social model.