累及胫骨平台后内侧柱复杂骨折:“竹筏”型及后内侧支撑钢板的置入  

Complex tibial plateau fractures involving posteromedial column: implantation of “bamboo raft” plate and posteromedial support plate

作　　者：韩志伟[1,2] 赵杰[2] 辛杰[2] 

机构地区：[1]潍坊医学院,山东省潍坊市261053 [2]山东省潍坊市人民医院骨创伤外科,山东省潍坊市261041

出　　处：《中国组织工程研究》2015年第9期1416-1422,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:累及胫骨平台后内侧骨折多为高能量损伤所致复杂型骨折,如不能选择合适时机、采用合理的固定入路及固定方式,则易出现局部皮肤坏死、骨折延迟愈合或不愈合、内固定失败及膝关节功能障碍等不良并发症。目的:探讨累及胫骨平台后内侧柱的复杂胫骨平台骨折的固定方法及效果。方法:以CT三维重建为基础和胫骨平台的三柱分型理论为依据,回顾性分析复杂胫骨平台骨折累及后内侧柱的患者37例资料。所有病例施行固定治疗,采用前外侧切口及后内侧切口固定入路,外侧利用国际内固定研究学会"竹筏"型解剖锁定接骨板固定,后内侧柱根据骨折情况选择此锁定支撑钢板固定,并行骨诱导人工骨植骨,按Merchant评分标准膝关节功能恢复情况。结果与结论:患者均获得平均12.8个月随访。骨折均达到临床愈合标准,无并发症出现。膝关节功能恢复情况:优25例,良9例,可2例,差1例,优良率92%。结果证实,前外侧切口结合后内侧切口+胫骨外侧"竹筏"型钢板及后内侧支撑钢板内固定,并应用骨诱导人工骨植骨治疗累及胫骨平台后内侧柱的胫骨平台骨折可以取得良好的治疗效果。BACKGROUND：Medial tibial fracture after involvement of the tibial plateau is complex fractures caused by high-energy injuries. If we cannot choose the appropriate time, reasonable fixation approach and fixation way, local skin necrosis delayed fracture healing or non-healing, internal fixation failure and knee joint dysfunction wil occur. OBJECTIVE：To investigate the method and effect of complex tibial plateau fractures of medial column after involving the tibia platform. METHODS：On the basis of CT three-dimensional reconstruction and three-column type theory tibial plateau, data of 37 patients with complex fractures of tibial plateau involved in the medial column were retrospectively analyzed. Al cases received fixation treatment. Anterior lateral incision and medial incision fixation approaches were used. The lateral side used“bamboo raft”type anatomic locking plate fixation, formulated by Association for the Study of Internal Fixation. Posteromedial column used this locking fixation plate according to fracture situation. Moreover, artificial bone graft was performed. The recovery of knee joint function was assessed using Merchant scoring criteria. RESULTS AND CONCLUSION：Al patients were fol owed up for 12.8 months averagely. Fractures achieved clinical healing standard. No complications appeared. Recovery conditions of knee joint function are as fol ows：excel ent in 25 cases, good in 9 cases, average in 2 cases, and poor in 1 case, with excel ent and good rate of＆nbsp;92%. Results confirmed that after anterior lateral incision combined with posteromedial incision＋tibia lateral“bamboo raft”steel plate and posteromedial support steel plate fixation in the treatment of tibial plateau fractures involving in posteromedial column of tibial plateau using artificial bone graft obtained good therapeutic effects.

关 键 词：植入物 骨植入物 胫骨骨折 胫骨平台骨折 植骨 后内侧柱骨折 支撑钢板 双切口双钢板内固定 骨折固定 生物力学 

分 类 号：R318[医药卫生—生物医学工程]