多板钉排筏式固定治疗复杂胫骨平台骨折  

Multi-plate-and-raft-type fixation for complex tibial plateau fractures

作　　者：赵加军 许庆龙 梅仁俊 何恒 韩玉[1] ZHAO Jia-jun;XU Qing-Long;MEI Renjun;HE Heng;HAN Yu(Department of Traumatology,Bangde Orthopaedics Hospital,Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学邦德骨科医院创伤科,江苏南京210018

出　　处：《中国矫形外科杂志》2020年第8期743-746,共4页Orthopedic Journal of China

摘　　要：[目的]介绍多板钉排筏固定治疗复杂胫骨平台骨折的手术技术和临床疗效。[方法] 2017年7月~2019年10月本院手术治疗Schatzker分型V^VI型复杂的胫骨平台骨折患者15例。肢体肿胀消退、皮肤出现皱褶、软组织情况满意后为切开复位内固定手术时机,通常为伤后3~14 d。采用前外、后内倒"L"联合切口完成断端及平台关节面的显露与复位固定。对关节面骨折块进行开窗撬拨或隧道顶托复位。复位满意后选用自体骨或异体骨植骨,1~2块T型或重建钢板塑形后固定后侧柱。屈膝位下于前外切口进行外侧柱骨折复位及钢板螺钉固定,将主力钢板螺钉,置于胫骨平台软骨下骨的下方,以起到支撑作用,达到多板钉排筏式固定效果。[结果]术后切口愈合良好,无一例出现感染及皮肤软组织坏死,无血管神经损伤,骨折及关节面复位满意,内固定无松动断裂,膝关节功能恢复优良率达93.33%。[结论]多板钉排筏式固定可以达到坚强固定,利于早期膝关节功能康复,有效减少术后并发症。[Objective] To introduce the surgical technique and clinical outcomes of multi-plate and screw raft fixation in the treatment of complex tibia plateau fractures. [Methods] From July 2017 to October 2019, 15 patients with complex tibial plateau fracture of the Schatzker type V and VI underwent surgical treatment in our hospital. The surgical timing was determined from 3 to 14 days after injury, as soon as subsidence of the extremity edema, accompanied with skin wrinkle and the soft tissue condition improved. Combined an anterolateral incision with a revers L-shaped posteromedial incision were made to expose and reduce the fractures. The fractured articular surfaces were restored by poking reduction through a fenestration or bone tunnel.After satisfactory reduction, bone autograft or allograft was filled into the bone defect, and 1 or 2 plates were used to reconstruct the posterior column of proximal tibia through the postmedial approach, while plates fixed the lateral column through the antero-lateral approach with screw passed subchondral bone on the main plate to for raft-type fixation. [Results] The incision healed well in all the patients after the operation, without neurovascular injury, infection and soft tissue necrosis in anyone of them. Satisfactory reduction of the joint surface achieved in all of them, with excellent and good knee function in 93.3%. [Conclusion] The multi-plate and raft-type fixation does achieve the strong fixation for complex tibia plateau fractures, which is beneficial to the rehabilitation of the early-stage knee joint function and effectively reduce the postoperative complications.

关 键 词：胫骨平台骨折 联合切口 多板钉排筏式固定 功能康复 

分 类 号：R683.42[医药卫生—骨科学]