应用打压植骨与大块植骨治疗塌陷型胫骨平台骨折的疗效分析

Effect of strut bone grafting for collapse fracture of tibial plateau compared to impaction bone grafting

目的探讨应用大块植骨与打压植骨治疗塌陷型胫骨平台骨折的疗效比较。方法将72例Schatzker分型为Ⅱ型及Ⅲ型的患者随机分为研究组(35例)和对照组(37例),研究组采用植骨时先填入少量松质骨颗粒后再用大块植骨(全层自体髂骨块)支撑,对照组打压植骨。对比两组间关节面塌陷≥2mm、≥3mm、轴向对位不良>5°的患者例数,Rsmussen膝关节功能评分及出现感染,内固定松动、断裂,骨延迟愈合、不愈合、二次植骨等并发症的发生率的差异。结果研究组和对照组的年龄、性别、体重等一般资料的差异无统计学意义。关节面塌陷≥2mm的研究组患者有3例,对照组患者10例,差异有明显的统计学意义(P=0.042);塌陷≥3mm的研究组患者1例,对照组患者4例;轴向对位不良>5°的研究组患者(n=0)明显少于对照组患者(n=3)。Rsmussen膝关节功能评分中疗效优的研究组患者(n=24)明显较对照组患者(n=17)多,差异有明显的统计学意义(P=0.042);研究组患者的优良率(94.3%)高于对照组患者(86.5%)。两组间各有一例切口感染,无内固定松动、断裂,无骨延迟愈合,无骨不愈合,均无二次植骨的情况发生。结论胫骨平台骨折Schatzker分型为Ⅱ型及Ⅲ型的患者采用植骨时先填入少量松质骨颗粒后再用大块植骨(全层自体髂骨块)支撑与打压植骨相比,有更低的高度丢失率及更好的膝关节功能结果,是可行的有效办法。

Objective To investigate the effect of strut bone grafting for collapse fracture of tibia1 plateau. Methods Seventy-two patients with Schatzker type Ⅱ and type Ⅲtibial plateau fracture were randomly divided into study group（n =-35）and control group（ n = 37）. Study group with particles of cancellous bone grafting and strut bone grafting（full layer of autologous iliac bone）, the control group with impaction bone grafting. Follow-up included the number of articular surface collapse≥2 mm, ≥3 mm, axial malalignment 〉 5°, Rsmussen knee score and infection, fixation with loosening or fracture, delayed bone healing, nonunion, secondary bone grafting. Results There were no significant differences in age, sex and weight of the patients and the fracture patterns. The number of the patients of the study group （n = 3 ）had significantly lower at articular surface collapse ≥ 2 mm than the control group （P = 0. 042）. Significant differences were found in articular surface collapse ≥3 mm between the study group （ n = 1 ） and the control group （n = d）, and axial malalignment 〉 5 °between the study group （n = 0）and the control group （n = 3 ）. The number of excellent Rsmussen knee score of study group were higher than that of control group and there were significant differences （P = 0. 042 ）. There were higher excellent and good rate in the study group than the control group.. Between the two groups each with one case of wound infection, no internal fixation loosening or fracture, no delayed bone healing or nonunion,no secondary bone graft. Conclusions Patients with Schatzker type Ⅱ and type Ⅲ tibial plateau fracture using a small amount of particles of cancellous bone grafting and strut bone grafting （full layer of autologous iliac bone） compared with impaction bone grafting, may have lower height loss rating and better knee function. Thus,it is a feasible and effective method and is worth popularizing in clinical practice.