胫骨近端关节内骨折不同植入物内固定的比较

Comparison of different implants for internal fixation of intra-articular fractures of the proximal tibia

背景:胫骨近端关节内骨折为复杂类型的关节周围骨折,其最佳植入物内固定治疗方法的选择一直是临床关注的焦点。目的:探讨不同植入物内固定在胫骨近端关节内骨折中的应用方法和治疗效果,以选择合适的植入物内固定方法,提高治疗水平。方法:2006年4月至2012年5月在解放军第401医院骨二科采用不同植入物内固定方式治疗胫骨近端关节内骨折合并韧带组织损伤患者41例,骨折按Schatzker分型,Ⅳ型18例,Ⅴ型12例,Ⅵ型11例;骨缺损者同时予以植骨;同时或二期行韧带组织修复,观察骨折愈合及功能恢复情况。结果与结论:41例患者随访6-36个月,植入物内固定治疗效果参照膝关节Bristol评分标准,32-50分,平均46分,优20例,良13例,可8例,优良率80%。有29例于治疗后12-28个月取除内固定植入物。治疗方法根据不同骨折类型而选择,要做到良好复位,坚强内固定,在胫骨近端关节内骨折的植入物内固定方法选择上,采用Liss锁定钢板能给骨折端提供最大的稳定性,骨折发生轴向和侧向偏差的概率最低,并发症的发生率也最低,是最佳选择。

BACKGROUND： Intra-articular fractures of the proximal tibia are complex periarticular fractures, for which, the best implant is the focus of clinical attention. OBJECTIVE： To explore the application methods and therapeutic effects of different implants in the internal fixation of intra-articular fractures of the proximal tibia in order to choose the appropriate implants. METHODS： From April 2006 to May 2012, 41 patients with intra-articular fractures of the proximal tibia combined with ligament tissue injury were selected at the Second Department of Orthopedics, the 401stHospital of Chinese PLA, who had received different implant internal fixations. According to the Schatzker classification, there were 18 cases of type IV, 12 of type V, and 11 of type VI. Bone defect also be bone; simultaneously or two rows ligament tissue repair observed fracture healing and functional recovery. Bone grafting was given in patients with bone defects, and ligament tissue repair was done simultaneously or at the second stage. Fracture healing and functional recovery were observed. RESULTS AND CONCLUSION： All the 41 patients were followed up for 6-36 months. Bristol scores in all the patients were 32-50, with a mean score of 46. Excellent was in 20 cases, good in 13 cases, and fair in eight cases. The excellent-good rate was 80%. Implants were removed in 29 of 41 cases within 12-28 months after treatment. Treatment methods are selected based on the type of fractures. Good reduction and stable internal fixation are necessary. Less Invasive Stabilization System can provide the maximal stability and lead to lowest probability of axial and lateral fracture deviation and the lowest incidence of complications, which is the best choice.