股骨外侧髁环锯取骨法与传统髂骨翼外侧板取骨法在胫骨平台骨折合并骨缺损治疗中的对比研究  

A retrospective trial of taking bone graft from lateral femoral condyle using trepan versus taking bone graft from lateral plate of iliac ala for tibial plateau fracture combined with bone defect

作　　者：徐云钦[1] 李强[1] 申屠刚[1] 苏佩华[1] 王刚[1] 姚有榕[1] 邓盼[1] 罗正理[1] 魏强强[1] 汤勇[1] 

机构地区：[1]中国人民解放军第九八医院,浙江湖州313000

出　　处：《中医正骨》2013年第10期9-13,共5页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：南京军区医学科技创新面上A类项目(11MA009);国家实用新型专利(ZL201220121958.2)

摘　　要：目的:比较股骨外侧髁环锯取骨法与传统髂骨翼外侧板取骨法在治疗胫骨平台骨折合并骨缺损中的临床疗效与安全性。方法:回顾性分析55例胫骨平台骨折合并骨缺损患者的病例资料,其中采用自制环锯取骨器于股骨外侧髁取骨25例(A组),采用骨刀于髂骨翼外侧板取骨30例(B组);SchatzkerⅢ型10例,Ⅴ型26例,Ⅵ19例。记录并比较2组患者的切口长度、术中出血量、手术时间、取骨量、骨折愈合时间及术后并发症的发生情况。参照Merchant膝关节功能评分标准评定2组患者的临床疗效。结果:①一般指标。A组患者的切口长度、术中出血量、手术时间均小于B组[(2.86±0.42)cm,(3.98±0.65)cm,t=7.449,P=0.000;(295.50±68.55)mL,(389.20±97.55)mL,t=4.389,P=0.000;(1.53±0.26)min,(1.86±0.30)min,t=4.390,P=0.000];2组患者取骨量、骨折愈合时间比较,组间差异无统计学意义[(12.45±1.97)cm3,(12.15±1.78)cm3,t=0.229,P=0.820;(144.00±21.41)d,(140.30±16.66)d,t=0.998,P=0.323]。②临床疗效。A组优13例、良9例、可2例、差1例,B组优14例、良12例、可3例、差1例。2组患者临床疗效比较,差异无统计学意义(Z=-0.363,P=0.717)。③安全性。A组患者发生并发症2例,B组患者发生并发症9例。A组并发症发生率低于B组(χ2=4.125,P=0.042)。结论:对于SchatzkerⅢ、Ⅴ、Ⅵ型胫骨平台骨折患者而言,虽然股骨外侧髁环锯取骨法与传统髂骨翼外侧板取骨法在取骨量、骨折愈合时间及临床疗效方面无明显差异,但股骨外侧髁环锯取骨法具有创伤小、操作简单、手术时间短、并发症少等优点,是治疗胫骨平台骨折合并骨缺损的一种较理想的方法,值得临床推广应用。Objective：To compare the clinical curative effect and safety of taking bone graft from lateral femoral condyle using trepan versus taking bone graft from lateral plate of iliac ala for tibial plateau fracture combined with bone defect.Methods：The clinical records of 55 patients with tibial plateau fracture combined with bone defect were analyzed retrospectively.Twenty-five patients （group A）were taken bone graft from lateral femoral condyle using homemade trepan,while the others（group B）were taken bone graft from lateral plate of iliac ala using osteotomes.The fractures belonged to Schatzker types Ⅲ（10）,Ⅴ （26） and Ⅵ （19）.The incision length,blood loss,operative time,volume of bone graft,fracture healing time and postoperative complications were recorded and compared between the 2 groups.The clinical curative effects were evaluated according to Merchant knee joint function scores.Results：The incision length,blood loss and operative time of group A were less than those of group B （2.86 ＋/-0.42 vs 3.98 ＋/-0.65 cm,t =7.449,P =0.000 ;295.50 ＋/-68.55 vs 389.20 ＋/-97.55 mL,t =4.389,P =0.000 ; 1.53 ＋/-0.26 vs 1.86 ＋/-0.30 min,t =4.390,P =0.000）.There was no statistical difference in volume of bone graft and fracture healing time between the 2 groups （12.45 ＋/-1.97 vs 12.15 ＋/-1.78 cm （3）,t =0.229,P =0.820 ; 144.00 ＋/-21.41 vs 140.30 ＋/-16.66 days,t =0.998,P =0.323）.Thirteen patients obtained excellent outcomes,9 good,2 fair and 1 poor in the group A,While 14 patients obtained excellent outcomes,12 good,3 fair and 1 poor in the group B.There was no statistical difference in the clinical curative effects between the 2 groups （Z =-0.363,P =0.717）.Two patients developed complications in the group A,while 9 patients developed complications in the group B.The complication rate of the group A was lower than that of the group B （x2 =4.125,P =0.042）.Conclusion：There is no significant difference in volume of bone graft,fracture healing time and clinical cura

关 键 词：胫骨骨折 胫骨平台 骨缺损 环锯取骨器 骨移植 治疗 临床研究性 

分 类 号：R687.3[医药卫生—骨科学]