中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (13): 2458-2462.doi: 10.3969/j.issn.1673-8225.2011.13.042

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

双侧钢板置入内固定治疗复杂胫骨平台骨折：同一机构6年17例随访

李  舰，蒋  林，周  忠，邓必权   

  1. 武汉市中心医院骨外科，湖北省武汉市  430014
  • 收稿日期:2010-11-25 修回日期:2011-01-26 出版日期:2011-03-26 发布日期:2013-10-23
  • 作者简介:李舰★，男，1979年生，湖北省黄冈市人，汉族，2009年华中科技大学同济医学院毕业，硕士，主治医师，主要从事关节及创伤骨科的研究。 elijian@163.com

Dual plating through two separate incisions for repair of complicated tibial plateau fractures: Six-year follow-up of 17 cases in an institute

Li Jian, Jiang Lin, Zhou Zhong, Deng Bi-quan   

  1. Department of Orthopaedics, Central Hospital of Wuhan, Wuhan  430014, Hubei Province, China
  • Received:2010-11-25 Revised:2011-01-26 Online:2011-03-26 Published:2013-10-23
  • About author:Li Jian★, Master, Attending physician, Department of Orthopaedics, Central Hospital of Wuhan, Wuhan 430014, Hubei Province, China elijian@163.com

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摘要：

背景：对于复杂性胫骨平台骨折，单块接骨板只提供胫骨平台一侧的稳定，容易形成偏心支撑，存在成角畸形倾向；另一方面，仅使用外侧支持钢板而忽视后内侧骨皮质的完整性，置入后易出现膝关节内翻畸形。采取双侧钢板置入内固定可有效增加固定强度，防范胫骨平台内外髁塌陷，避免置入后膝关节内外翻畸形。
目的：观察双切口双侧钢板置入内固定治疗复杂胫骨平台骨折的临床疗效。
方法：选择2004-02/2010-05武汉市中心医院骨科收治的复杂胫骨平台骨折患者17例，男11例，女6例；年龄19~54岁，平均33.6岁；左膝9例，右膝8例。按照AO分型：B型5例，C型12例；按照Schatzker分型：Ⅳ型3例，Ⅴ型9例，Ⅵ型5例。在受伤后6~10 d水肿及软组织反应消退后采用双切口双侧钢板置入内固定治疗，同一患者使用同一家公司的双钢板，置入后第1天起即开始行CPM机功能锻炼并扶拐非负重行走。
结果与结论：17例患者均获得随访，随访时间8~72个月。1例陈旧性胫骨平台骨折钢板置入后膝关节僵硬，1例开放性骨折钢板置入后出现伤口感染经治疗后愈合，其余患膝胫骨关节面均最终生长平整，下肢力线恢复正常。根据Merchant评分标准进行综合评定，优9例，良6例，中1例，差1例，优良率为88.2%。所有病例中未见与材料有关的不良反应，显示双钢板与宿主之间具有良好的生物相容性。

关键词: 胫骨平台骨折, 双钢板, 内固定, 疗效, 生物相容性

Abstract:

BACKGROUND: When using single plate for treating complicated tibial plateau fractures, it can only provide one-end stability of tibial plateau, result in eccentrically braced frames and prone to angular deformity. On the other hand, using lateral branch plate but neglecting cortical bone integrity easily leads to knee joint internal inversion. Dual plating through two separate incisions can increase the strength of fixation, prevent lateral condyle collapse and avoid deformity of internal and external inversion after operation.
OBJECTIVE: To evaluate the clinical effects of treatment of complicated tibial plateau fractures with dual plating through two separate incisions.
METHODS: A total of 17 patients with complicated tibial plateau fractures were selected from Department of Orthopaedics, Central Hospital of Wuhan between February 2004 and May 2010. There were 11 males and 6 females, aged 19-54 years and mean age of 33.6 years; left knee in 9 cases, right knee in 8 cases. According to AO classification: type B in 5 cases, type C in 12 cases; according to Schatzker classification: type Ⅳ in 3 cases, type Ⅴ in 9 cases and type Ⅵ in 5 cases. Surgical treatment with dual plating was implemented when edema and soft tissue reaction subsided at 6-10 days after injury happened. All cases were received reduction and bone graft on operation, moreover exercises with CPM machine and non-weight-bearing walking with crutches to recover the function of knee joint went on gradually from the first day after operation.
RESULTS AND CONCLUSION: All patients were followed up for 8-72 months, an average of 25.9 months. Knee stiffness appeared in 1 case of old fractures of the tibial plateau after operation. Postoperative wound infection appeared in 1 case of open fractures was healed after treatment. Finally smooth articular surface of knee and normal limb lines appeared in all other cases. According to Merchant evaluation system, the knee function was excellent in 9 cases, good in 6 cases, fair in 1 case and poor in 1 case. The excellent and good rate was 88.2%. No material related adverse effect happened, which showed that dual plates have good biocompatibility.

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