摘要
目的回顾性分析双切口双钢板置入内固定治疗Ⅳ、Ⅴ、Ⅵ型胫骨平台骨折患者的效果。方法以十堰市太和医院2011年1月—2015年8月收治的24例Ⅳ、Ⅴ、Ⅵ型胫骨平台骨折患者作为研究对象,其中男性14例,女性10例;年龄21～56岁,平均34. 1岁。Ⅳ型6例,Ⅴ型11例,Ⅵ型7例,患者于伤后7～12d软组织和水肿反应明显消退后,置入双切口双钢板进行内固定处理,并且在置入后第1天行持续被动运动(CPM)机功能锻炼,同时嘱咐患者进行扶拐非负重行走锻炼。记录患者术中出血量、手术时间、骨折愈合时间、完全负重时间,并评价其伤口愈合情况。结果 24例患者治疗后均获电话随访,随访时间为6～24个月,平均19. 1个月。其中2例开放性骨折患者钢板置入后发生伤口感染,1例陈旧性胫骨平台骨折患者出现膝关节僵硬,均通过对症处理后症状明显改善,余21例患者患膝胫骨关节面均能平整生长,下肢力线恢复至正常。24例患者中,膝关节功能评分优13例,良9例,可1例,差1例,优良率为91. 7%(22/24);均无与内固定材料有关的不良反应。结论双切口双钢板置入内固定治疗Ⅳ、Ⅴ、Ⅵ型胫骨平台骨折能够明显改善患者膝关节功能,其不良反应程度轻,经对症处理后可明显改善,提示其具有较高的安全性,并且生物相容性良好。
Objective To study the effect of double incision and plate internal fixation for the treatment of IV,V,VI tibial plateau fractures in 24 cases. Methods A total of 24 cases（14 males and 10 females with an average of 34.1 （21-56） years） of IV,V and VI tibial plateau fractures in our hospital were selected as the subjects,of which 6 cases of type IV,11 cases of type V,and 7 cases of type VI. After 7-12 days when soft tissue and edema reaction subsided,the double incision and plates was implemented as internal fixation treatment. On the first day continuous passive motion functional exercise after stent placement was started and non-weight-bearing exercise was done. The blood volume,operation time,bone union time,weight bearing time and healing condition of all patients were bserved and recorded. Results All the 24 patients were followed up for 6-24 months by telephone,with an average of 19.1months. Among them,2 cases of wound infection occurred in patients with open fractures after plate implantation,1 case of stiffness of knee joint occurred in an old tibial plateau fracture patients. All the 3 patients had symptoms improved significantly by symptomatic treatment,and the rest 21 cases had smooth growth of knee tibial articular surface,and the force line of lower limb was restored to normal. Among the 24 patients,the knee function score was excellent in 13 cases,good in 9 cases,fair in 1 case and poor in 1 case,with the excellent and good rate of 91.7% （22/24）. There was no adverse reaction associated with the material in any patient. Conclusion Double incision and plate internal fixation can significantly improve the knee function in patients with type IV,V and VI tibial plateau fractures,with slight adverse reactions,and symptomatic treatment can obviously relieve the symptoms,suggesting that it has high safety and good biocompatibility.
作者
冯振中
李勇
康中山
FENG Zhen-zhong;LI Yong;KANG Zhong-shan(Department of Emergency,Shiyan Taihe Hospital（Affiliated Hospital of Hubei University of Medicine）,Shiyan,Hubei 442000,China;Department of Orthopedics,Shiyan Taihe Hospital（Affiliated Hospital of Hubei University of Medicine）,Shiyan,Hubei 442000,China)
出处
《创伤外科杂志》
2018年第10期740-743,共4页
Journal of Traumatic Surgery
关键词
胫骨平台骨折
双切口
双钢板
内固定
tibial plateau fracture
double incision
double plate
internal fixation
