β-磷酸三钙结合T型锁定钢板植入治疗单纯胫骨平台后外侧塌陷骨折

Treatment of simple posterolateral tibial plateau collapse fracture with beta-tricalcium phosphate combined with T-shaped locking plate

背景:单纯胫骨平台后外侧塌陷骨折在临床上非常少见,对于该区域的塌陷移位骨折必须进行解剖复位关节面,并选择合适的填充材料及内固定物牢固固定。目的:探讨β-磷酸三钙结合T型锁定钢板经改良后外侧入路治疗单纯胫骨平台后外侧塌陷骨折的稳定性、临床疗效及生物相容性。方法:选择2013年6月至2017年12月苏州大学附属张家港医院收治的15例单纯胫骨平台后外侧塌陷骨折患者,其中男性8例,女性7例,年龄25-53岁,均采用β-磷酸三钙结合T型锁定钢板经改良后外侧入路固定治疗。术后随访12个月,膝关节X射线片观察骨折愈合及内固定情况,Rasmussen放射学评分评估骨折复位效果,HSS膝关节功能评分、Lachman试验、Pivot-shif试验及侧方应力试验评估膝关节功能及稳定性。试验已通过苏州大学附属张家港医院伦理委员会批准,批准号:201305KS001。结果与结论:①术后所有患者膝关节骨折均解剖复位,骨折愈合时间9-14周;术后12个月β-磷酸三钙基本完全吸收,被新生骨替代,骨缺损处均获得满意修复;②15例患者术后12个月与术后即刻的胫骨外侧平台后倾角与内翻角度数、Rasmussen影像学塌陷评分、Rasmussen影像学总评分比较差异均无显著性意义(P>0.05);③术后12个月,15例患者的膝关节HSS评分89-100分,Lachman试验、Pivot-shif试验及侧方应力试验均阴性;④随访期间未发生植入物周围感染、过敏反应、免疫反应及排斥反应;⑤结果表明,采用β-磷酸三钙结合T型锁定钢板经改良后外侧入路治疗单纯胫骨平台后外侧塌陷骨折,具有良好的修复效果与生物相容性。

BACKGROUND:Simple posterolateral tibial plateau collapse fracture is very rare in the clinic.The displaced collapse fracture in this area must be anatomically reduced,filled with suitable materials,and fixed with internal fixators.OBJECTIVE:To evaluate the stability,clinical results and biocompatibility of modified posterolateral approach to treat simple posterolateral tibial plateau collapse fracture with beta-tricalcium phosphate combined with T-shaped locking plate.METHODS:Fifteen patients with simple posterolateral tibial plateau collapse fractures who received surgical treatment between June 2013 and December 2017 in Zhangjiagang Hospital Affiliated to Soochow University.These patients included 8 males and 7 females,aged 25-53 years.All of them received surgical treatment with beta-tricalcium phosphate combined with T-shaped locking plate through the modified posterolateral approach.After surgery,they were followed up for 12 months.X-ray examination was performed to evaluate fracture healing and internal fixation.Reduction effect was evaluated by Rasmussen radiology score.Knee function and stability were evaluated by HSS knee function score,Lachman test,pivot-shift test and lateral stress test.This study was approved by Medical Ethics Committee,Zhangjiagang Hospital Affiliated to Soochow University,China(approval No.201305KS001).RESULTS AND CONCLUSION:(1)All patients underwent anatomical reduction of knee fractures,and the fracture healing time was 9-14 weeks.At 12 months after surgery,β-tricalcium phosphate was completely absorbed and replaced by new bone,and repair of bone defect was satisfactory.(2)There were no significant differences in posterior tibia angle,varus angle,Rasmussen imaging collapse score and Rasmussen imaging total score between 12 months after surgery and immediately after surgery in 15 patients(P>0.05).(3)At 12 months after surgery,the HSS score of the knee joint was 89-100,and Lachman test,pivot-shift test and lateral stress test results were negative in 15 patients.(4)During the follow up period,infection around implants,allergic reaction,immune reaction,or rejection reaction was not observed.(5)These findings suggest that treatment of simple posterolateral tibial plateau collapse fracture through the modified posterolateral approach withβ-tricalcium phosphate combined with T-shaped locking plate exhibits good repair effects and biocompatibility.