摘要
目的探讨双反牵引一期微创治疗同侧股骨骨折合并胫骨平台骨折的手术次序、要点和临床应用价值。方法回顾性分析2015年10月至2017年1月期间治疗的5例新鲜股骨骨折合并同侧胫骨平台骨折患者资料。男4例，女1例；年龄23～65岁，平均45．5岁。股骨骨折按照AO／OTA骨折分型：A型2例，B型2例，C型1例；胫骨平台骨折采用Schatzker分型：Ⅴ型2例，Ⅵ型3例。手术先固定胫骨平台，于股骨髁上、胫骨远端置入克氏针，应用双反牵引器闭合复位胫骨平台并微创置入接骨板；接着继续应用股骨髁上牵引针，同一套双反牵引器另一端固定于髂前上棘，闭合复位股骨骨折后应用髓内钉固定。收集术后骨折愈合、膝关节功能恢复情况，并统计住院时间。结果5例患者术后获7-17个月（平均10个月）随访。股骨骨折和胫骨平台骨折均无延迟愈合、畸形愈合发生。临床愈合时间：股骨骨折平均为5．5个月（4—8个月），胫骨平台骨折平均为12．0周（10～14周）。末次随访时膝关节屈曲平均110°（95°～130°），总体功能恢复按照Kadstrom和Olerud评价标准评定：优2例，良3例。平均住院时间为18d（13～31d）。结论应用双反牵引器一期微创治疗同侧股骨骨折合并胫骨平台骨折，可以获得良好的功能结果，并且可以极大地缩短住院时间。
Objective To investigate the fixation sequence, key points and clinical value of a new minimally invasive surgery for one-stage treatment of femoral and ipsilateral tibial plateau fractures with a rapid reductor. Methods From October 2015 to January 2017, 5 patients with femoral and ipsilateral tibial plateau fractures received surgery at our department. They were 4 men and one woman, aged from 23 to 65 years （mean, 45.5 years）. The femoral fractures were type A in 2 cases, type B in 2 cases and type C in one case according to AO/OTA classification. The tibial plateau fractures were type V in 2 cases and type V[ in 3 according to Schatzker classification. After the tibial plateau fractures were first fixated, Kirschner wires were inserted via the femoral condyle and distal tibia. A rapid reductor was used to reduce the tibial plateau and dual plates were implanted by percutaneous minimally invasive internal fixation. Then the same set of rapid reductor was used to treat femoral fractures by antegrade femoral nailing. The bone traction was completed via the femoral condyle and anterior superior iliac spine. The operative time, bone union time, knee functional recovery and hospital stay were recorded. Results The 5 patients were followed up for an average of 10 months （from 7 to 17 months）. No delayed union, nonunion or malunion happened of either femoral or tibial plateau fractures. The healing time for femoral fractures ranged from 4 to 8 months, averaging 5.5 months; the union time for tibial plateau fractures ranged from 10 to 14 weeks, averaging 12.0 weeks. The knee flexion averaged 110°（from 95° to 130°） . The overall functional recovery was rated as excellent in 2 cases and good in 3 according to the Karlstrom ＆ Olerud criteria. The average hospital stay was 18 days（from 13 to 32 days） . Conclusion Minimally invasive surgery with a rapid reductor can treat femoral and ipsilateral tibial plateau fractures at one stage, leading to fine functional recovery of the knee and greatly reduced ho
出处
《中华创伤骨科杂志》
CSCD
北大核心
2017年第10期840-845,共6页
Chinese Journal of Orthopaedic Trauma
关键词
股骨
胫骨
骨折固定术
内
一期
微创
Femur
Tibia
Fractures fixation, internal
One stage
Minimally invasive
