锁定多向带锁髓内钉治疗胫骨平台骨折  

Tibial locking multidirectional interlocking intramedullary nail for fractures of tibial plateau

作　　者：张庆杰[1] 王永清[1] 熊庆广 郝晓辉[1] 熊超[1] 尹鸣熹[1] 毕红宾[1] 赵志辉[1] 

机构地区：[1]天津医科大学第四中心临床学院骨科,300140

出　　处：《中华骨科杂志》2016年第13期833-840,共8页Chinese Journal of Orthopaedics

基　　金：天津市卫生局科技基金项目（09ky08）

摘　　要：目的：探讨胫骨锁定多向带锁髓内钉（tibial locking multidirectional interlocking intramedullary nail, TLMIIN）治疗胫骨平台骨折的临床疗效。方法回顾性分析2008年10月至2012年5月采用TLMIIN治疗并获得随访的38例闭合性胫骨平台骨折患者资料，男22例，女16例；年龄28~67岁，平均48.7岁；左侧24例，右侧14例；均为新鲜骨折，受伤至手术时间1~18 d，平均6 d。胫骨平台骨折采用AO/OTA分型：B1型4例，B2型1例，B3型14例，C1型8例，C2型5例，C3型6例。其中采用闭合复位TLMIIN固定患者4例（10.5%，4/38），采用有限切开复位TLMIIN固定患者34例（89.5%，34/38）。术后采用改良Hohl？Luck胫骨平台骨折评价系统评估疗效。结果38例患者均获得随访，随访时间11~23个月，平均18.1个月。骨折均获骨性愈合，时间48~131 d，平均87.4 d；完全负重时间80~128 d，平均108.9 d。取出TLMIIN前1 d，按Hohl？Luck系统评估，其中功能评价：优28例，良8例，可2例，优良率94.7%（36/38）；放射学评价：优23例，良9例，可6例，优良率84.2%（32/38）。术后随访期间无一例发生感染、锁钉松动及断裂、畸形愈合及不愈合。术后膝关节和小腿肿胀严重6例，经抗凝、脱水、理疗等对症治疗，7 d后肿胀均消失；切口少量渗出液2例，细菌培养结果均为阴性，分别在术后16 d和18 d愈合，但皮缘出现少许干性结痂坏死；术后1周，1例因负重发生复位丢失，膝内翻25°，未做处置，未影响骨愈合和关节功能。结论利用TLMIIN的髓内支撑、限制性和非限制性多向立体固定技术治疗胫骨平台骨折疗效满意，提供一个新的治疗方法，软组织的二次损伤范围小，相应降低术后并发症。Objective To observe the clinical effects of tibial locking multidirectional interlocking intramedullary nail （TLMIIN） for tibial plateau fractures. Methods 38 cases with closed tibial plateau fractures treated by TLMIIN from October 2008 to May 2012 were retrospectively analyzed. There were 22 males and 16 females, with an average age of 48.7 years （range, 28-67 years）. There were 24 fractures on the left side while the other 14 factures were on the right side, which were all fresh frac？tures. According to AO/OTA classification of tibial plateau fractures, there were 4 cases of B1, 1 case of B2, 14 cases of B3, 8 cas？es of C1, 5 cases of C2 and 6 cases of C3. Close reduction were performed on 4 cases （10.5%of all cases）. Open reduction were performed on the other 34 cases. The limited incision was decided by the distribution of the fragments and fracture line. Hohl？Luck evaluation system was applied for the follow？up. Results The mean follow？up period was 18.1 months （range, 11-23 months）. All fractures were healed at an average period of 87.4 days （range, 48-131 days）. The average time from operation to full weight？bearing was 108.9 days （range, 80-128 days）. Hohl？Luck evaluation system was used in the final follow？up. The excellent and good rate of functional score was 94.7%（36/38）, including 28 cases excellent, 8 cases good and 2 cases fair from functional as？pect. The excellent and good rate of radiological score was 84.2%（32/38）, including 23 cases excellent, 9 cases good and 6 cases fair from radiological aspect. No complications such as infection, breakage and loosening of the screw, malunion, nonunion oc？curred at the time of the latest follow？up. 6 cases with serious swelling of the knee joint and the soft tissue of crus were cured by an？ticoagulation, dehydration and physiotherapy treatments after operation. The 2 cases with a little exudates and incrustation was bacterial cultured negative and healed after 16 days and 18 days on the incision. 1 c

关 键 词：胫骨骨折 骨折固定术 髓内 内固定器 治疗结果 

分 类 号：R687.3[医药卫生—骨科学]