外固定支架治疗合并髁部骨折的胫骨干复杂骨折

External bracket fixation for tibia diaphysis complex fracture involving proximal and distal articular fractures

目的探讨合并髁部骨折的胫骨干复杂(C2、C3型)骨折的外固定支架手术治疗方法及临床效果评价。方法对1999年1月-2004年1月通过手术治疗的累及胫骨近、远端骨折的42例胫骨干粉碎性骨折患者的治疗结果进行分析。按AO/ASIF原则分类,胫骨干骨折均为C2型(多段骨折)、C3型(不规则)骨折；累及踝关节19例,累及膝关节23例；手术采用简单内固定加外固定架固定及单纯外固定架固定。结果42例患者全部获随访,功能满意35例(83%),可6例(14%),不满意1例(2%)。结论通过外固定支架的方法可使合并髁部骨折的胫骨干复杂(C2、C3型)骨折最大限度地恢复胫骨与腓骨骨的相对长度、胫骨管状结构重建、关节面的平整、膝-踝关节面的平行对称关系,术后配合合理的康复锻炼,能使膝、踝关节功能达到最大的恢复。

Objective To evaluate the clinical outcome of external bracket fixation in the treatment of complex tibia diaphysis fracture involving intra-articular fractures. Methods Forty-two cases of complex tibia diaphysis fracture with proximal and distal intra-articular fractures treated surgically in our hospital from January 1999 to January 2004 were analyzed. The complex tibia diaphysis fractures were categorized according to the AO classification as type C2 （ multiple segments fracture） and type C3 （ irregular fracture）, proximal and distal intra-articular fractures in 23 and 19 cases, respectively. Definite operation was done within one week. Twenty-two cases were treated with simple external fixator, and 20 cases treated with screws and external fixator. Results All the 42 cases were followed-up regularly. According to AO evaluation of the knee and ankle joint movement, 83% （35/42 cases） of the cases gained satisfactory functional outcome, 14% （6/42 cases） had quite satisfactory results and 2% （ 1/42 case） had unsatisfactory functional outcome. Conclusion External bracket fixation can obtain outcome of relative length of the tibia and fibula, tube structure reconstruction, smoothness of the articular surface and the parallel and symmetric relation of knees and ankles for complex tibia diaphysis fracture with proxi- mal and distal intra-articular fracture. The arthritis resulting in pain in movement and restriction of function is considered to be the most important factor affecting the joint function. Early functional exercise is important for best recovery of knee and ankle function.