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华西医学  2011 

复杂型胫骨平台骨折手术策略及疗效分析

, PP. 890-892

Keywords: 胫骨平台骨折,双钢板,内固定术

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Abstract:

【】 目的 探讨复杂型胫骨平台骨折改良手术入路及双侧双钢板固定临床疗效。 方法 2006年3月―2008年12月,收治复杂型胫骨平台骨折21例,其中男14例,女7例;平均年龄37岁。按Schatzker骨折分类Ⅴ型10例,Ⅵ型11例。均选择前外侧联合后内侧或后侧入路,双侧双钢板固定,术中探查半月板及交叉韧带损伤,一期修复处理及行交叉韧带重建。 结果 术后伤口Ⅰ期愈合19例,Ⅱ期愈合1例,1例术后10d发生切口皮缘坏死,经换药后愈合。所有患者均获1~3年随访,平均19.5个月。骨性愈合时间5~10个月,平均7.4个月。出现创伤性关节炎2例,关节面塌陷2例,其中1例有轻度膝关节内翻。按美国特种外科医院评分标准优18例,良2例,可1例,优良率95.2%。 结论 复杂型胫骨平台骨折运用前外侧联合后内或后侧切口入路,双侧双钢板固定,利于保护软组织血供、固定可靠稳定性好,是切实可行的有效方法。【Abstract】 Objective Tostudytheclinicalefficacyofmodifiedsurgicalapproachandbilateraldouble-platefixationinthecasesofcomplextibialplateaufracture. Methods FromMarch2006toDecember2008,21patientswithcomplextibialplateaufracture,including14malesandsevenfemales,weretreatedinourhospital.Theaverageageofthemwas37yearsold.BasedonSchatzkerfractureclassification,therewere10casesoftypeⅤand11casesoftypeⅥfracture.Allthecasesweretreatedbythecombinedanterolateralandposteromedialorposteriorapproachesandbilateraldouble-platefixation.Intheoperation,weexploredinjuriesonthemeniscusandcruciateligament,andcarriedouttheone-stagerehabilitationandcruciateligamentreconstruction. Results Therewere19casesofone-stagehealing,andonecaseofsecondaryhealing.Onepatientsufferedskinflapnecrosis10daysaftertheoperation,andwascuredafterchangingthemedicine.Allthepatientswerefollowedupforonetothreeyears,averagingat19.5months.Bonehealingoccurredwithin5to10monthsaveragingat7.4months.Twopatientssufferedtraumaticarthritis;articularsurfacecollapsewasfoundintwopatients;andonepatienthadmildvarusknee.AccordingtothescoringsystemfromHospitalforSpecialSurgery,therewere18casesofexcellentefficacy,twoofgoodefficacy,oneoffairefficacy,withanexcellencerateof85.2%. Conclusion Combinedanterolateralandposteromedialorposteriorapproachesandbilateraldouble-platefixationforcomplextibialplateaufracturesisbeneficialtoprotectthesofttissuebloodsupplyandgivereliablefixationstability.Thus,itisafeasibleandeffectivemethodandisworthfurtherresearchandpopularizinginclinicalpractices.

References

[1]   Gardner MJ, Yacoubian S, Geller D, et al. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients[J]. J Orthop Trauma, 2005, 19(2): 79-84.
[2]   Canale ST. 坎贝尔骨科手术学[M]. 9版. 卢世壁, 译. 济南: 山东科技出版社, 2001: 2048-2049.
[3]   李新忠, 陈道运, 胡珍珠, 等. 复杂性胫骨平台骨折的治疗(120例随访分析)[J]. 中国矫形外科杂志, 2008, 16(22): 1739-1740.
[4]   刘志雄. 骨科常用诊断分类方法和功能结果评定标准[M]. 北京: 北京科学技术出版社, 2005: 125-275.
[5]   曾炳芳, 罗从凤. 重视胫骨近端骨折的治疗[J]. 中华创伤骨科杂志, 2004, 6(3): 241-243.
[6]   Sommer C, Gautier E, Müller M, et al. First clinical results of the loching compression plate (LCP)[J]. Injury, 2003, 34 (Suppl 2): 43-54.
[7]   Egol KA, Su E, Tejwani NC, et al. Treatment of complex tibial plateau fractures using the less invasive stabilization system plate: clinical experience and a laboratory comparison with double plating[J]. J Trauma, 2004, 57(2): 340-346.
[8]   Mills WJ, Nork SE. Open reduction and internal fixation of high-energy tibial plateau fractures[J]. Orthop Clin North Am, 2002, 33(1): 177-198.
[9]   Wu CC, Tai CL. Plating treatmena for tibial plateau fractures: a biomechanical comparison of buttress and tension band positions[J]. Arch Orthop Trauma Surg, 2007, 127(1): 19-24.
[10]   Westmoreland GL, McLaurin TM, Hutton WC. Screw pullout strength: a biomechanical comparison of large-fragment and small fragment fixation in the tibial plateau[J]. J Orthop Trauma, 2002, 16(3): 178-181.
[11]   Gosling T, Schandelmaier P, Muller M, et al. Single lateral locked screw plating of bicondylar tibial plateau fractures[J]. Clin Orthop Relat Res, 2005, 439: 207-214.
[12]   Stannard JP, Wilson TC, Volgas DA, et al. The less invasive stabilization system in the treatment of complex fracturse of the tibial plateau: short-term results[J]. J Orthop Trauma, 2004, 18(8): 552-558.
[13]   G?sling T, Schandelmaier P, Marti A, et al. Less invasive stabilization of complex tibial plateau fractures: a biomechanical evaleation of a unilateral locked screw plate and double plating[J]. J Orthop Trauma, 2004, 18(8): 546-551.
[14]   葛志斌, 张前法, 庞清江. 重组合异种骨加钢板内固定治疗胫骨平台骨折[J]. 中国修复重建外科杂志, 2004, 18(4): 272-274.

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