胫骨平台骨折与创伤性关节炎的防治

Treatment of Tibial Plateau Fracture and Traumatic Arthritis

目的探讨胫骨平台骨折受损关节面软骨的早期修复和严重晚期创伤性关节炎关节面的重建。方法对４２例胫骨平台骨折除重视骨折复位外，对部分剥脱、掀起的关节软骨予以复位并采用丝线或细钢丝抽出缝合修复，对缺如软骨裸露关节面，根据其大小、深浅分别用骨形成蛋白－纤维蛋白粘合剂（ＢＭＰ－ＦＳ）复合片或附以带蒂骨膜瓣翻转修复。结果本组有９例发生创伤性关节炎包括３例严重的晚期创伤性关节炎。对此３例严重晚期创伤性关节炎采用ＢＭＰ－ＦＳ覆盖，术后随访６～２４个月，关节面及关节间隙恢复正常，疼痛消除，膝关节屈伸增加３０°。

Objective To study the early repair of the damaged articular cartilage in tibial plateau fractures and the re establishment of the articular surface in serious late traumatic arthritis.Methods Fractures of tibial plateau in 42 cases were treated with open reduction.In addition,the stripped and lifted parts of articular cartilage were reposited and fixed with silk thread or thin wire,and the cartilage uncovered articular surface due to defect of cartilage was covered with the bone morphogenetic protein fibrin sealant (BMP FS) or repaired with the pediculated periosteum flap,respectively.Results Traumatic arthritis occurred in 9 cases,including 3 cases with serious late traumatic arthritis.The articular surface in these 3 cases was trimmed once again and covered with BMP FS.By following up of 6 24 months,their articular surface and joint space were recovered to normal,pain was relieved,and the flexion and extension of the knee joint were increased by 30 degree.Conclusion BMP FS can be used in the repair of early defect of articular cartilage and in the re establishment of the articular surface in late serious traumatic arthritis.