人工骨和自体骨植骨治疗胫骨平台骨折临床比较研究

Comparison of β-tricalcium phosphate and autogenous bone graft for defect augmentation in tibial plateau fractures

目的比较研究人工骨和自体骨植骨治疗胫骨平台骨折的临床疗效。方法对33例胫骨平台Ⅱ、Ⅲ型骨折行切开复位后，18例行人工骨（β-TCP）植骨钛板内固定，15例行自体骨植骨钛板内固定。随访12—24个月，根据Merchant评分评价关节功能恢复情况，根据x线表现评价胫骨平台术后塌陷情况。结果两组术后关节功能恢复按Merchant评分无显著性差异（P〉0．05）。胫骨平台术后再塌陷〉2mm的患者自体骨组有13例，占本组患者总数的86．7％，人工骨组12例，占66．7％，两组比较无显著性差异（P〉0．05）。自体骨组胫骨平台术后再塌陷发生时间多在术后2周至12周，而人工骨组再塌陷时间多在术后6周至6个月，后者发生再塌陷时间较前者明显延迟。结论人工骨植骨钛板内固定在预防平台骨折术后关节再塌陷较白体骨植骨具有优势。

Objective To comparatively study the clinical efficacy between autogenous bone and artificial bone （β- tricalcium phosphate） graft for defect augmentation in tibial plateau fractures. Methods Thirty-three acute, closed and unstable tibial plateau fractures （ Schatzker type Ⅱ and Ⅲ） were under open reduction and internal fixation, among which 18 fractures were fixed by β-tricalcium phosphate graft and Titanium plate and 15 fractures, autogenous bone graft and Titanium plate. Arthrosis function recovery was evaluated based on Merchant scale and defect augmentation in tibial plateau after surgery was valued according to X-ray film by 12 - 24 months of follow up. Results There is no significant difference between the two groups＇ arthrosis function recovery after surgery （P 〉 0.05）. There are 13 patients （86.7%） in autogenous bone group with re-defect more than 2 mm after surgery in tibial plateau and 12 patients （66.7%）, in artificial bone group（P 〉0.05）. The re-defect of autogenous bone group mainly happened from 2 to 12 weeks after the surgery in tibial plateau, while the re-defect of artificial bone group, mainly from 6 weeks to 6 months. The time of re-defect of artificial bone postponed significantly than that of autogenous bone. Conclusion Open reduction and internal fixation with β-tficalcium phosphate and Titanium plate had more advantages than that with autogenous bone graft and Titanium plate in tibial plateau fractures at the prevention of arthrosis defect augmentation.