自制T形三维支架抗分离加压螺钉撬拨治疗胫骨平台骨折

Treatment for fracture of tibial plateau by T three dimensional cage and anti-splitting compression screw

目的 :观察T形三维支架抗分离加压螺钉经皮撬拨治疗胫骨平台骨折的疗效。方法 :首先手法矫正移位 ,残余移位则从胫骨一侧平台下做小切口 ,用撬拨器撬拨推挤骨块 ,塌陷≥ 5mm时用环钻植骨器取髂骨柱填塞。复位满意 ,在距关节面 1～ 1 5cm处平行拧入 1枚加压螺钉 ,再拧入螺母压紧 ,若骨块粉碎状 ,则加上带齿弧垫环抱。同法处理对侧骨块 ,将 2枚螺钉锁定到半环架上 ,再在胫骨中、上段前内侧拧入 2枚普通外固定螺钉并锁定在单臂架上 ,组合半环单臂支架。结果 :2 2例按Schatzker分类 :Ⅱ型 5例 ,Ⅲ型 6例 ,Ⅳ型 3例 ,Ⅴ型 4例 ,Ⅵ型 4例。平均随访 2 7年。均在 3个月内愈合 ,膝关节活动度平均 12 0°以上 ,无螺钉断裂、折弯、滑脱 ,无膝内外翻、感染。 16例达到解剖复位 ,6例接近解剖复位 ,按Hohl评分标准 ,优 15例 ,良 6例 ,可 1例。结论 :该法适应范围广 ,操作简便、固定可靠、创伤小、可早期功能锻炼 ,疗效好 ,便于临床推广。

Objective: To observe the effect of treatment for fracture of tibial plateau by T three dimensional cage and anti splitting compression screw. Methods: Replaced the displacement with maneuver.Remained displacement was made a micro incision through the one lateral of the tibial plateau.Pushing the bone block by the pry.When the subside was ≥5 mm,ilium column of trephine grafting was filled up.If the reduction was satisfactory,then parallelly screwing a compression screw 1～1 5 cm to the articular surface and screwing a nut to press tightly.If the bone was broken into pieces,adding teeth arch pad to surround.The same method could be used to deal with the other,locking two screws on the half annular cage,and then screwing two ordinary screw on the upper and middle part of the tibia and locking on the one arm cage to form a half annular kickstand. Results: Twenty two patients were classified according to Schatzker:type Ⅱ 5,type Ⅲ 6,type Ⅳ 3,type Ⅴ 4,type Ⅵ 4.Following up for 2 7 years on average revealed that fractures were all healed in three months.The motion of knee joint were all higher than 120 degree.No screw broken,crooked and dislocated.Praising the curative effect as the Hohl standard:15 excellent,6 good and 1 fair. Conclusion: This method is easy to be operated and the fixation is safe with micro incision.This method can be acted early and the curative effect is perfect and worth developing. Key words Fracture of tibial plateau; External fixator; Surgical instruments Treatment for fracture of tibial plateau by T three dimensional cage and anti splitting compression screw$$$$ TAN Lei ,WANG Jing yan,ZHANG Li,ZHANG Zhen peng,DONG Yong dong,WU Sheng,ZHAO Xing wei. Weifang TCM Hospital,Shandong Weifang,261041,China Abstract Objective: To observe the effect of treatment for fracture of tibial plateau by T three dimensional cage and anti splitting compression screw. Methods: Replaced the displacement with maneuver.Remained displacement was made a micro incision through the one lateral of the tibial plateau.Pushing the bone block by the pry.When the subside was ≥5 mm,ilium column of trephine grafting was filled up.If the reduction was satisfactory,then parallelly screwing a compression screw 1～1 5 cm to the articular surface and screwing a nut to press tightly.If the bone was broken into pieces,adding teeth arch pad to surround.The same method could be used to deal with the other,locking two screws on the half annular cage,and then screwing two ordinary screw on the upper and middle part of the tibia and locking on the one arm cage to form a half annular kickstand. Results: Twenty two patients were classified according to Schatzker:type Ⅱ 5,type Ⅲ 6,type Ⅳ 3,type Ⅴ 4,type Ⅵ 4.Following up for 2 7 years on average revealed that fractures were all healed in three months.The motion of knee joint were all higher than 120 degree.No screw broken,crooked and dislocated.Praising the curative effect as the Hohl standard:15 excellent,6 good and 1 fair. Conclusion: This method is easy to be operated and the fixation is safe with micro incision.This method can be acted early and the curative effect is perfect and worth developing.