自断加压骨栓联合接骨板治疗胫骨平台骨折的疗效

Easily-breaking compression bone bolt plus bone plate for treatment of tibial plateau fracture

目的探讨自断加压骨栓联合接骨板治疗胫骨平台骨折的临床效果。方法回顾性分析2018年7月至2018年12月间应用河北医科大学第三医院创伤急救中心自断加压骨栓联合接骨板治疗的12例胫骨平台骨折患者资料。男8例,女4例;年龄20~65岁,平均45.6岁;左侧6例,右侧6例。根据Schatzker分型:Ⅰ型1例,Ⅱ型3例,Ⅲ型3例,Ⅳ型2例,Ⅴ型1例,Ⅵ型2例。测量并比较术前、术后X线片上胫骨平台宽度,记录手术时间、出血量及骨折愈合时间。随访是否出现术后复位丢失及其他手术并发症,末次随访时应用Rasmussen评分系统评价患者的膝关节功能。结果本组患者手术时间平均54.6 min,出血量平均25 mL。骨折愈合时间平均17.2周,无骨折不愈合或延迟愈合。术后胫骨平台宽度(78.9±7.2)mm,较术前(87.4±6.1)mm变窄,差异有统计学意义(P<0.05),无术后复位丢失和手术伤口并发症发生。2例患者出现下肢深静脉血栓形成,经治疗后痊愈。末次随访时Rasmussen评分系统评估膝关节功能;优9例,良2例,可1例。结论自断加压骨栓联合接骨板治疗胫骨平台骨折不但能恢复胫骨平台宽度,而且骨折块挤压牢固可早期功能锻炼,膝关节康复较好。

Objective To evaluate our self-designed easily-breaking compression bone bolt plus bone plate in the treatment of tibial plateau fracture.Methods From July 2018 to December 2018,12 patients with tibial plateau fracture were treated at Emergency Center of Trauma,The Third Hospital of Hebei Medical University using our self-designed easily-breaking compression bone bolt plus bone plate.They were 8 males and 4 females,aged from 20 to 65 years(average,45.6 years),with 6 left sides and 6 right sides injured.According to Schatzker classification,there were one case of type I,3 cases of typeⅡ,3 cases of typeⅢ,2 cases of typeⅣ,one case of typeⅤand 2 cases of typeⅥ.The width of tibial plateau was measured and compared before and after operation on X-ray films.Operation time,blood loss and fracture union time were recorded.Loss of reduction and postoperative complications were followed up.Knee function was evaluated at the final follow-up by Rasmussen scoring.Results For this cohort,operation time averaged 54.6 min,blood loss 25 mL,and fracture union time 17.2 weeks.No nonunion or delayed union was observed.The postoperative width of tibial plateau was(78.9±7.2)mm,significantly narrower than the preoperative value[(87.4±6.1)mm](P<0.05).No loss of reduction or surgical complications occurred postoperation.Deep venous thrombosis of the lower extremity developed in 2 patients but recovered after treatment.The Rasmussen scoring for knee joint function at the final follow-up yielded 9 excellent,2 good and one poor.Conclusion In treatment of tibial plateau fractures,our self-designed easily-breaking compression bone bolt plus bone plate can restore width of tibial plateau,compress fracture fragments tightly and allow for early exercise,leading to fine functional recovery of the knee joint.