应用微创可注射型植骨材料结合内固定治疗胫骨平台骨折

The use of minimally invasive injectable graft and internal fixation in tibial plateau fractures

目的评估微创可注射型植骨材料(MIIG)结合内固定治疗胫骨平台骨折的优势。方法回顾性分析采用MIIG结合内固定方法治疗的13例胫骨平台骨折患者的临床资料,与年龄、性别、骨折类型较为相似且行自体髂骨植骨结合内固定治疗的13例患者的资料进行比较。对比手术并发症的发生率、胫骨平台关节软骨面的复位及手术后1年的软骨面再塌陷情况、膝关节功能恢复等情况。结果全部患者均获得随访,随访时间12～50个月,平均18个月。MIIG结合内固定治疗的患者在胫骨平台关节软骨面术后1年再塌陷和手术并发症发生率方面较自体髂骨植骨结合内固定治疗有显著优势,在膝关节功能恢复和手术后即刻关节软骨面复位等方面无显著差异。结论MIIG结合内固定治疗胫骨平台骨折的最大优点在于减少术后并发症的发生和有效防止关节软骨面的再塌陷,是骨外科治疗胫骨平台骨折的有效方法。

Objective To value the use of an injectable minimally invasive calcium sulfate cement for displaced tibial plateau fractures. Methods Thirteen patients with lateral tibial plateau fractures treated with internal fixation and bone grafting were matched with 13 patients treated using internal fixation and an injectable calcium sulfate cement. The clinical data were retrospectively analyzed. All patients were followed up for a minimum of one year. The peri-operative complication, quality of reduction, maintenance of reduction, function assessment and development of post-traumatic osteoarthritis was compared in both groups. Results Ten patients in the internal fixation and bone graft group had excellent anatomical reductions as judged on immediate post-operative radiographs but some loss of reduction on follow-up at one year was observed in 8 of the 13 （61%） cases. Twelve patients from the MIIG group had an excellent reduction on immediate post-operative radiographs but 3 （23%）demonstrated some loss of reduction of the plateau at one year follow-up （ P 〈 0. 05 ）. Conclusions The use of MIIG and internal fixation is associated with more favourable clinical results than conventional treatment with internal fixation and bone grafting for lateral tibial plateau fractures.