双钢板治疗胫骨平台严重粉碎性骨折的体会

Experience of double plating for the treatment of severe comminuted tibial plateau fracture

目的探讨特殊类型的胫骨平台严重粉碎性骨折的治疗方法。方法对胫骨平台骨折中按Schatzke分类的(Ⅴ型、Ⅵ型)骨折行双钢板固定:我科在2000年1月至2007年12月:(1)先用克氏针或尖端复位钳临时将平台的各骨块固定;(2)将塌陷的平台复位,用松质骨将平台骨缺损处填充紧密;(3)用克氏针或尖端复位钳再将平台与骨干固定;(4)用两板钢板行胫骨平台内外侧固定。(5)胫骨结节撕脱的平台骨折复位后应固定或修补胫骨结节及髌韧带。结果本组18例骨折术后即开始功能活动,3例用石膏托固定4周后开始活动,随访0.5年～6年,未发生骨不连,其中2例术后切口感染,优良率达90.5%。结论应用双钢板内固定治疗特殊类型的胫骨平台粉碎骨折,固定可靠,且术后可早期进行功能活动,减轻了伤后关节功能受限的程度,同时早期功能活动能增加骨折面的应力,防止骨质疏松,促进骨愈合。

Objective To explore the therapeutic method of special type of severe comminuted tibial plateau fracture. Methods According to schatzker classification, type Ⅴ and Ⅵ tibial plateau fractures were operated with two-incision approaches and double-plates fixation： （1）previsionally fixed the pieces of fracture with kirschner pin or apical reduction clamp. （2）The collapsed plateau was reduced and the defect was filled with cancellous bone. （3）Fixed the plateau and stem with kisschner pin or apical reduction clamp. （4）Fixed with double plates on lateral and medial tibial plateau. （5） Tibial plateau fracture with bibial bubercle avulsion should be fixed or repaired with the tibial tubercle or patellar ligament after reduction. Results FunctionM activity was performed in 18 cases after operation. 3 patients exercised after 4 weeks, gypsum frxed. All cases were followed-up for 0.5 to 6- year, there was none nonumion and 2 cases occurred incisional infection after operation. The excellent and good rates were in 90.5%. Conclusion Treatment of special type of comminuted bibial plateau fracture with double plates fixation has reliable fixation and early exercise would increase the stress of fracture surface, promote bone healing and prevent osteoporosis.