闭合复位有限固定治疗胫骨平台骨折  

The use of minimally invasive procedure in treatment of tibial plateau fractures

作　　者：庞桂根[1] 王宏川[1] 忻大明[1] 张铁良[1] 

机构地区：[1]天津医院创伤骨科,天津市300211

出　　处：《中华骨科杂志》2003年第12期723-727,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨采用闭合复位有限固定治疗胫骨平台骨折的可行性及疗效.方法自1999年10月～2002年1月,共治疗胫骨平台骨折42例,男29例,女13例;年龄26～67岁,平均41岁.按照Schatzker分类法,I型9例,Ⅱ型5例,Ⅲ型13例,Ⅳ型3例,V型6例,Ⅵ型6例.对胫骨平台骨折中劈裂骨折块采用闭合复位,塌陷骨折块采用经皮空心钉导针撬拨复位,复位后均用直径6.5 mm空心钉固定,对不稳定性骨折加用Bastiani单臂外固定器.结果术后随访37例,随访时间6～30个月,平均15个月;骨折均在12周内愈合,无一例术后发生神经血管损伤及深部感染等并发症.本组37例患者中有21例解剖复位,Sanders膝关节评分法评定结果为优8例,良11例,可2例;16例非解剖复位均属SchatzkerⅡ、V、Ⅵ型,其疗效评定为优5例,良9例,可2例.两组之间比较差异无显著性意义(Wilzoxon检验,P＞0.05).所有病例均恢复了患肢的正常力线,患膝稳定.结论闭合复位有限固定是治疗胫骨平台骨折的有效方法之一,其对膝关节创伤小,可恢复患肢的正常力线及患膝的稳定,固定可靠,术后可早期进行膝关节功能锻炼,患肢功能恢复好,并发症少.Objective To explore the efficacy of closed reduction and inter na l fixation of cannulated screws by minimally invasive procedure in management of tibial plateau fractures. Methods From October 1999 to January 2002, 42 patient s with tibial plateau fractures, which were 29 males and 13 females with an aver age age of 41 years ranging from 26 to 67 years, were treated surgically in our hospital. According to Schatzker system, the fractures were diagnosed as type Ⅰ in 9, type Ⅱ in 5, type Ⅲ in 13, type Ⅳ in 3, type Ⅴ in 6 and type Ⅵ in 6. There was open fracture in 5, and closed fracture in 37. The fracture fragments of tibial plateau were reduced with closed manipulation or reduced assisted by minimally invasive procedure. The later by minimally invasive procedure included two kinds of reductions, one of which was reduction assisted by Kirschner pin t hat was introduced percutaneously into the larger fragment; the other was reduct ion assisted by a bone tamper that was introduced through a small incision into the cortical window beneath the depressed articular surface. Fixation was achiev ed using percutaneous 6.5 mm cannulated screws or combination of the cannulated screws and Bastiani external frame in unstable fractures. Results Of 42 patients , 37 were followed up from 6 to 30 months (average, 15 months). All 37 fractures were united within 12 weeks postoperatively. The mechanical axis of affected li mb and the stability of affected knee joint were restored in the patients. Accor ding to Sanders score for functional results of knee joint, 13 patients were rat ed as excellent, 20 good, and 4 fair. Anatomical reduction was identified while the stepping of articular surface after reduction was less than 2 mm. In 21 pati ents with anatomical reduction, the functional results were excellent in 8, good in 11, and fair in 2. However, in 16 patients without anatomical reduction, the functional results were excellent in 5, good in 9, and fair in 2. There was sig nificant difference between the two groups o

关 键 词：闭合复位有限固定 治疗 胫骨平台骨折 Bastiani单臂外固定器 

分 类 号：R687[医药卫生—骨科学]