锁定加压钢板外置治疗胫骨中下段骨折

External locking compression plate in treatment of middle and distal tibial fractures

目的探讨锁定加压钢板(locking compression plate,LCP)外置治疗胫骨中下段骨折的手术技巧和临床疗效。方法 2012年8月~2013年1月,我院共对9例患者采用LCP外置治疗胫骨中下段骨折,其中男7例,女2例,年龄25~51岁,平均32.3岁。6例为闭合性骨折,3例外开放性骨折均为Anderson-Gustilo分型的Ⅰ型。骨折AO分类:A型5例,B型4例。术后采用Johner-Wruhs标准进行功能评分和影像学X线片评价此手术方法的临床疗效。结果 9例患者均获得临床随访,随访时间14~22个月,平均16.5个月,9例患者骨折愈合良好,骨折临床愈合时间为13~19周,平均13.6周。1例患者因为组织损伤严重出现局部组织坏死,换药后伤口愈合良好,1例患者出现螺钉变形,通过减少患者负重,未出现螺钉断裂。最后一次随访Johner-Wruhs评分:优5例,良4例。结论 LCP外置治疗胫骨中下段骨折具有创伤小、易操作、对骨折局部血运影响小、临床效果可靠的优点。

Objective To explore the clinical effectiveness and skills of using LCP to treat the middle and distal tibial fractures.Methods From August 2012 to January 2013,total of 9 patients,7 males and 2 females,with the middle and distal tibial fractures were treated by external fixation with LCP,the average age of the patients at surgery was 32.3 years,ranging from 25 to 51 years old.According to Anderson-Gustilo classification,all the cases were type Ⅰ,ahout two third of the pstients were close fractures and one third were open fractures,based on AO classification system,the fractures comprised of 5 cases of type A,4 cases of type B.The effects of the treatments were analyzed in terms function recovery which evaluated according to Johner-Wruhs standed system,and to the radiography findings.Results 8 cases' incision healed by first intention,the edge of incision necrosis occured in 1 case,but healed after dressing change.Screw deformation observed in 1 patient,though reducing weight,it did not fractured.The average follow-up period was 16.5 months(14 to 22 months).The average time of healing fracture was 13.6 weeks(13 to 19 weeks).The last followup according to Johner-Wruhs score the results were evaluated as excellent in 5 cases,good in 4 cases.Conclusion Using LCP to treat the middle and distal tibial fractures has small trauma,less bleeding,the less complications and clicinal treatment effect is good.