骨质疏松性胫骨平台骨折的手术治疗

Surgical treatment for the osteoporotic fractures of the tibial plateau

目的评估应用锁定加压钢板(LCP)治疗骨质疏松性胫骨平台骨折的近期疗效。方法 2006年6月～2009年6月,对32例骨质疏松性胫骨平台骨折行切开复位内固定术治疗,其中男20例,女12例,年龄56～72岁,平均年龄63.5岁。骨折采用Schatzker分型,Ⅱ型10例,Ⅲ型8例,Ⅳ型6例,Ⅴ型7例,Ⅵ型1例。本组术前骨密度测量(DEXA)值为:0.55～0.82 g/cm2,平均0.71±0.18 g/cm2,提示本组存在骨质疏松。采用胫骨近端锁定加压钢板固定,平台塌陷较重者予Wright人工骨粒植入。术后早期行膝关节康复功能锻炼,同时予鲑鱼降钙素、钙剂、维生素D行规范抗骨质疏松治疗1～3个疗程。结果本组平台塌陷均满意复位,术后无骨筋膜室综合症及下肢深静脉栓塞等并发症发生。根据Sanders膝关节功能评分,优24例,良6例,可2例,优良率93.8%。随访1～4年,平均2.5年,所有患者均获骨性愈合,平台复位无丢失。结论 LCP治疗骨质疏松性胫骨平台骨折近期疗效满意,该术式具有固定可靠、创伤小、可早期行膝关节康复功能锻炼等优点,同时规范的抗骨质疏松治疗亦非常重要。

Objective To evaluate the short-term clinical outcomes of application of locking compression plate （LCP） for treatment of osteoporotic fractures of the tibial plateau. Methods Thirty-two patients （20 males and 12 females） with osteoporotie fractures of the tibial plateau, aged from 56 to 72 years old （63.5 years in average） , were treated with open reduction and internal fixation from June 2006 to June 2009. According to Sehatzker classification, there were type II 10 cases, type III 8 cases, type IV 6 cases, type V 7 cases, and type VI 1 cases. The preoperative bone mineral density measured using DEXA showed that the average values were 0.71 ＋0. 18 g/cm2 （0.55-0.82 g/cm2） , indicating the existence of osteoporosis. LCP was performed for the proximal tibia. Severe plateau collapse was treated with Wright artificial implant. Early rehabilitation training of knee joint and standard anti-osteoporosis treatment with salmon calcitonin, calcium and Vitamin D were recommended for 1 to 3 courses postoperatively. Results The plateau collapses in our study were succeeded with the reduction. No complications of compartment syndrome and deep vein thrombosis occurred. According to Sanders grading for the joint function, there were 24 cases graded as excellent, 6 cases as good, and 2 cases as acceptable. The overall satisfactory rate was 93.8%. All patients were followed up for 2. 5 years in average （ from 1 to 4 years）. All the fractures were healed and the plateaus were no loss during reduction. Conclusion Because of reliable fixation, minimal invasion and possible early rehabilitation training of the knee joint, LCP has been proven as a safe and effective implant for treatment of osteoporotic fractures of the tibial plateau. It is also very important to combine with standard anti-osteoporosis therapy.