定制钢板治疗膝、踝关节周围骨折的初期疗效

Individualized custom plates to treat fractures around the knee and ankle joints

目的探讨定制钢板治疗膝、踝关节周围骨折的方法和初期疗效。方法对2011年3月至9月收治的13例膝、踝关节周围骨折患者资料进行回顾性分析，均为男性；年龄19～64岁，平均39．8岁。骨折根据AO分型：B型1例，c型12例。骨折发生部位：股骨远端1例，胫骨近端6例，胫骨远端6例。人院后骨折部位均行三维CT扫描（层厚0-7mm），数据通过Mimics10．01软件分析，再经过计算机辅助设计软件UGNX7．0制作个性化钢板，局部消肿后行有限切开微刨定制钢板内剧定术。结果所有患者术后随访7～13个月，平均11.1个月；骨折愈合时间9～33周，平均12．8周，尤发牛骨折不愈合。膝、踝关节分别应用Neer、Baited—Jackson关节功能评分标准评定疗效：优9例，良3例，叶11例，优良率达92．3％。结论术前可以利用定制钢板很好地模拟术巾情况，定制钢板结合微创技术治疗膝、踝关节周围骨折可以取得肯定的初步疗效。

Objective To explore the therapeutic effects of individualized custom plates in tile treatment of fractures around the knee and ankle joints. Methods From March to September 2011. 13 patients with fractures around the knee and ankle joints were treated in our department. They were all male, aged from 19 to 64 years （average, 39.8 years）. According to AO classification, there were one case of type B and 12 of type C. One patient had a distal femoral fracture, 6 had a proximal tibial fracture and 6 had a distal tibial fracture. The-dimensional reconstruction of the fracture was conducted by means of software Mimics 10.01 after CT scanning （0. 7 mm per slice） for virtual simulation of the operation. The plates and screws were manufaetured after computer-assisted design using software UG NX7. O. Mininmlly invasive plate osteosynthesis （M1PO） was applied after local detumescenee to fixate the fractures with individualized cus｜nm plates and screws. Results The average following-up period was 11. 1 months, ranging fl＇om 7 to 13 months. The average time for fracture healing was 12.8 weeks, ranging fi＇om 9 to 33 weeks. No nonunion was found during the follow-up. According to the Neer and Baired-Jackson scoring systems for the knee and ankle joints, the functional recovery was evaluated as excellent in 9 cases, good in 3 cases and fair in one case. The good to excellent rate was 92.3%. Conclusions Virtual simulation of the internal fixation can be con- ducted pre-operation with an individualized custom plate to ensure satisfactory effects. Individualized custom plates and MIPO may achieve positive outcomes for fractures around the knee and ankle joints.