自制可调式固定器在胫骨上端累及平台骨折中的临床应用

Design and Application of Adjustable External Fixator for the Treatment of Fractures of Tibial Plateau

目的 探讨采用经皮三维可调式固定器治疗胫骨上端累及平台骨折的优、缺点。方法 对1995 ～1998 年12 例新鲜胫骨上端累及平台骨折应用上述方法治疗的情况进行分析。随访时间9～33 个月,12 例均获得随访,平均19.2 个月。结果 采用Hohl 膝关节功能评价方法判断临床疗效。优7 例,良4 例,可1 例。结论 正确掌握和运用固定器的使用技术是使胫骨上端骨折取得满意疗效的关键。本治疗方法优点为:(1)手术创伤小,固定可靠,患者可早期活动膝关节,操作简便、利于普及。(2)固定针只有四个点与皮肤接触,可使皮肤有伤口或感染者进行早期手术固定。(3) 半环框架与螺杆整体结构好,力学可靠、合理。固定针尾部有锁定装置,有效防止了针的松动脱出。(4) 通过垂直螺杆的可调性使固定器有支撑作用,也可利用肌群收缩增加骨折局部压应力。

Objective To study the adjustable external fixator for the treatment of fracture of tibial plateau. Methods Twelve patients with tibial plateau fracture were treated with external fixator from 1995 to 1998. The follow up period ranged from 9 to 33 months(mean: 19.2 months). Results The patients were evaluated by Hohl’s knee rating system, there were excellent in 7 case, good in 4 cases,fair in 1 case. Conclusion The key to obtain a good result is to master the technique and use the fixator correctly. There are four advantages for this method: (1) the device leads minor trauma, gives reliable fixation and allows early motion of the joint. (2) the device is specially suitable for open fracture or open infected fracture. (3) the structure of the device is reasonably designed; the end of the rod can be locked; this can protect loosening and dropping off. (4) the vertical rod can be adjustable to obtain effective support; muscle traction can produce stress on the fracture site,and this may improve fracture healing process.