开窗夯实植骨和填塞植骨治疗胫骨平台骨折临床疗效比较

Clinical Comparison Between Open-window with Punning Bone-Grafting and Packing Bone-grafting in Treatment of Tibial Plateau Fractures

目的：比较研究不同植骨方式治疗简单胫骨平台骨折的临床疗效。方法：对79例胫骨平台Schatzker分型Ⅱ型、Ⅲ型骨折行切开复位后,43例行开窗夯实植骨钢板内固定,36例行填塞植骨钢板内固定,植骨材料均采用人工骨。随访6～18个月,根据Rasmussen评分标准评价关节功能恢复情况,根据X线表现评价胫骨平台术后塌陷情况。结果：开窗植骨组术后关节功能恢复按Rasmussen评分明显优于填塞植骨组（P=0.022）。胫骨平台术后再塌陷〉2 mm的患者开窗夯实植骨组有4例,占9.30%,填塞植骨组11例,占30.56%,填塞植骨组胫骨平台术后再塌陷发生时间多在术后6周内,而开窗夯实植骨组再塌陷例数少且术后早期无关节面塌陷。结论：开窗夯实植骨治疗胫骨平台Ⅱ型、Ⅲ型骨折预防平台术后关节面再塌陷较填塞植骨具有优势。

Objective： To observe clinical effect of two different bone grafting methods in treatment of tibial plateau fractures. Method： 79 Cases of Schatzker Type II and III were divided into two groups, observation group （43 cases） and control group （36 cases）, each case performed OR_IF. The observation group were applied to open-window with punning bone-grafting method combining steel plate for internal fixation. The control group were performed packing bone-grafting method combining steel plate for internal fixation. Both group used artificial bone as grafting materials. A follow-up examination of 6 to 18 months was conducted. The condition of recovering joint function in each case were evaluate using Rasmussen scoring system and the denting conditions evaluated using X-ray imaging. Results： According to Rasmussen scores, patients in observation group witnessed better recovery than that in the control group （P=0.022）. After tibial plateau operation, there were 4 cases （9.30%） in observation group witnessed bigger-than-2 mm secondary collapse and 11 cases of the same condition （30.56%） in control group. In cases of control group, the secondary collapse usually occurred 6 weeks after operation, while in the cases of observation group, the occurrences of secondary collapse were fewer and in the early period of post-operation there was no secondary collapse in joint surface. Conclusion： In the treatment of type II and III tibial plateau fractures, open-window with punning bone-gratting method witnessed better clinical effect than packing bone-grafting method in preventing joint surface secondary collapse.