改良抗张力钢板固定胫骨结节骨骺损伤  

Modified anti-tension plate for fixation of tibial tubercular epiphyseal fracture

作　　者：陈磊 李阔阔 徐旭 何猛 李长润 刘黎军[1] 王大平[1] 王满宜 张胜利[1] CHEN Lei;LI Kuo-kuo;XU xu;HE Meng;LI Chang-run;LIU Li-jun;WANG Da-ping;WANG Man-yi;ZHANG Sheng-li(Department of Traumatic Orthopedics,The First Affiliated Hos-pital(Shenzhen Second People's Hospital),Shenzhen University,Shenzhen 518000,Guangdong,China)

机构地区：[1]深圳大学附属第一医院(深圳市第二人民医院)创伤骨科,广东深圳518000

出　　处：《中国矫形外科杂志》2025年第3期259-263,共5页Orthopedic Journal of China

基　　金：广东省高水平临床重点专科(深圳市配套建设经费)资助项目(编号:SZGSP007)。

摘　　要：[目的]介绍改良抗张力钢板治疗青少年胫骨结节骨骺损伤的技术和初步临床疗效。[方法]患者仰卧位,患肢外展中立位,膝关节屈曲25°。自胫骨结节前做长约5 cm切口,暴露髌腱止点在近端骨骺损伤处,清理骨折端血肿,冲洗后巾钳复位,3枚1.2金属导针临时固定。术中透视骨折良好复位后,纵劈髌腱,将改良抗张力钢板跨过骺板放置,1枚拉力螺钉加压固定后,再以2枚锁定螺钉固定。对于波及关节面的大块骨块,可用2枚3.5 mm空心螺钉固定。术毕注意缝合纵劈的髌腱。[结果]所有患者均顺利完成手术,住院时间平均(7.2±1.4) d。随访时间9~18个月,平均(15.0±1.4)个月。骨折愈合时间平均(2.2±0.2)个月。术后3~4个月恢复至正常运动水平。术后6个月手术取出内固定物。按照Mosier的临床疗效评估标准:17例为优,1例为良。[结论]采用改良抗张力钢板固定胫骨近端骨骺损伤可得到较为满意的结果,能使青少年快速恢复膝关节功能。[Objectives]To introduce the surgical technique and preliminary clinical consequence of modified anti-tension plate in the treatment of epiphyseal fractures of the tibial tubercle in adolescents.[Methods]The patient was placed in a supine position with the affected limb abducted to a neutral position,and the knee joint flexed at 25°.A 5 cm incision was made in front of the tibial tubercle,exposing the patellar tendon and the proximal epiphyseal fracture,As hematoma at the fracture ends was debrided and irrigated,the fracture was reduced with a towel clamp,and temporally fixed with 3 Kirschner wires 1.2 mm in diameter.After intraoperative fluoroscopy confirmed good fracture reduction,the patellar tendon was longitudinally split,a modified anti-tension plate was placed across the epiphyseal plate,and fixed with a compression screw,followed by 2 locking screws.If the large bone fragments involving the articular surface,another two 3.5 mm cannulated screws would be used for fixation.At the end of the procedure,an attention was given to suture the longitudinally split patellar tendon.[Results]All patients had the operation performed successfully,and were followed up time for 9 to 18 months,with an average of(15.0±1.4)months.The patients had fracture healed from 2 to 3.1 months,with an average of(2.2±0.2)months,regained normal level of activity 3 to 4 months after surgery,had implants removed 6 months postoperatively.According to Mosier's criteria,the clinical outcome was marked as excellent in 17 patients and good in 1 patient.[Conclusion]The modified tension plate to fix tibial tubercular epiphyseal fracture does obtain satisfactory clinical consequence with quick restoration of the knee function in adolescents.

关 键 词：青少年 运动性损伤 胫骨结节骨骺骨折 改良抗张力钢板 

分 类 号：R683.42[医药卫生—骨科学]