AO/ASIF-B1型胫骨平台骨折锁定钢板内固定术后即刻负重对患者临床效果的影响  

The Effects of Postoperative Immediate Weightbearing Following Locking Plate Osteosynthesis for Tibial Plateau Fracture Patients of AO /ASIF-B1

作　　者：刘海涛 胡勇 陈永红 

机构地区：[1]重庆市万盛经济技术开发区人民医院外二科,重庆400800

出　　处：《中国现代手术学杂志》2014年第4期276-279,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨AO/ASIF-B1型胫骨平台骨折锁定钢板内固定术后即刻负重对患者临床疗效的影响。方法回顾性分析2008年1月至2012年1月67例采用胫骨近端锁定钢板固定治疗的患者资料。根据患者的术后负重活动时间不同,将其分为延期负重组和即刻负重组,其中即刻负重组30例,延期负重组37例,两组在年龄、性别构成比及BMI方面,组间差异无统计学意义(P>0.05)。术后至少随访1年,随访中通过膝关节正位X线片评估胫骨平台关节面塌陷程度、内/外翻对线情况。在末次随访时,采用膝关节外科学会评分(Knee Society Score,KSS)评价患者的功能疗效。结果两组病例手术切口均一期愈合,未发生切口感染情况,随访中无病例出现内固定失败情况。术中置入的螺钉数量、及术中植骨率组间比较差异无统计学意义(P>0.05)。所有病例均获得至少1年的临床及影像学随访。术后1 d、8周、6个月及末次随访X线片显示,两组在关节面坍陷程度及内/外翻对线评估方面,组间差异均无统计学意义(P>0.05)。即刻负重组与延期负重组末次随访的KSS评分分别为85.5±6.9和82.8±7.8,组间差异无统计学意义(t=1.483,P=0.143)。结论 AO/ASIF-B1型胫骨平台骨折采用锁定钢板固定术后,可允许患者即刻开始进行负重活动训练。Objective To investigate the clinical effect of immediate weightbearing following locking plate osteosynthesis for tibial plateau fracture patients of AO/ASIF-B1 type. Methods Locking plate osteosynthesis was used in 67 partial articular proximal tibial fracture cases （ Arbeitsgemeinschaft fur Osteosynthesefragen type of 41B） from January 2008 to January 2012, whose clinical data were studied retrospectively. The patients were divided into two groups ; the first group was not allowed to bear weight for the first 6 to 8 postoperative weeks （ n = 37）, whereas the second group was allowed immediate postoperative weighthearing （n = 30）. The age, gender and BMI were not different between two groups. Postoperative depression of the tibial articular surface and varus-valgus （axial） were assessed by digital X-ray during the postoperative follow-up. At the last follow-up, the Knee Society Score （KSS） was used to evaluate the functional efficacy for all patients. Results Primary healing was achieved for all incision. To the last follow-up, internal fixa- tion loosening, failure or other complication was not found for all cases. Operative results in terms of use of bone allograft and number of screws inserted were comparable between groups （ P 〉 0.05 ）. All patients were followed up for at least 1 year. X-ray imaging at postoperative one day, eight weeks, six months and the final follow-up revealed that depression of the tibial articular surface and varus-valgus （axial） were not different between the groups （ P 〉 0.05 ）. KSS scores in immediate weight-bearing group and postponed weightbearing group at final follow-up were 85.5 ± 6.9 and 82.8 ± 7.8, respectively, with no statistically significant difference between the two groups （ t = 1. 483, P = 0. 143 ）. Conclusions This retrospective study suggests that immediate weightbearing following locking plate osteosynthesis of AO/ASIF-B1 tibial plateau fractures may be allowed.

关 键 词：胫骨骨折 内固定器 负重 康复 

分 类 号：R687.3[医药卫生—骨科学]