胫腓骨骨折固定物与固定方式的研究进展

背景：研究表明,血液供应和坚强牢固的骨折内固定存在不少冲突。胫骨和腓骨骨折患者手术治疗时人工内植物固定方式的选择,业已成为一个迫切需要解决的临床课题。目的：回顾近年来不同类型胫骨和腓骨骨折固定物及固定方式的文献研究,为胫骨和腓骨骨折临床治疗实践中客观合理地选择固定物提供参考和评价标准。方法：计算机检索PubMed数据库和中国期刊全文数据库（CNKI）于1990年1月至2012年5月有关胫腓骨骨折手术固定治疗的临床与基础实验研究,检索关键词分别为＂tibiofibularfracture,fixationmethod,researchprogress＂和＂胫腓骨骨折,固定方法,研究进展＂,排除发表时间较早或重复研究。结果与结论：①胫骨和腓骨拥有自己独特的解剖结构和生理功能,骨折固定稳定及血液供应保障,应在胫骨和腓骨骨折的治疗中首先考虑,手术之后早期进行功能锻炼是骨折恢复所必要的过程,也将很大程度上依赖骨折固定的稳定性。②以何种方式固定胫骨和腓骨骨折,应根据骨折部位、骨折类型、创伤污染程度、软组织损伤程度等多种因素决定。③严格执行经典AO骨折的固定和生物骨折固定的改良理论和技术显得非常重要。新型系列钢板和外固定支架的出现亦是值得研究的临床方向,外固定支架结合有限内固定的使用以及序贯治疗概念的提出有待进一步大样本实践研究。④解剖复位困难或严重损害邻近关节的特殊病例,关节镜或关节置换可以有效地提高骨折的预后并改善术后生活功能。通过经皮插入钢板内固定间接复位技术,降低了伤口愈合不良、感染、骨折延迟愈合、骨不连等不良后果的发生率,正逐渐成为胫骨远端粉碎性骨折的最佳选择,而配合符合生物学骨折内固定原则的锁定加压钢板器械设计使经皮插入钢板内固定得以成为值得推广的内固定技术。

Research progress of the fixity and fixation method for tibia and fibula fracture

BACKGROUND： Studies have shown that there is a controversy between blood supply and the fast fracture fixation. Selection of the suitable fixation method for the patients with tibia and fibula fracture is the important issue in face of every clinician. OBJECTIVE： To review various types of research literatures on tibia and fibula fracture fixation in recent years, in order to provide reference and evaluation criteria for objective and reasonable selection of tibia and fibula fracture fixation method.METHODS： A computer-based online search was performed in the PubMed database and the China National Knowledge Infrastructure database for the clinical and basic experimental research papers on the surgical fixation of tibia and fibula fracture from January 1990 to May 2012. The key words were ＂tibiofibular fracture, fixation method, research progress＂ in Chinese and English. The articles published earlier and repetitive researches were excluded.RESULTS AND CONCLUSION： ①Due to the special anatomy structure and physiologic function of tibia and fibula, the first step in the treatment of the fracture is to consider how to balance the blood supply and stability,and the functional exercise must be practiced as soon as possible after fixation, which will rely on a stable fixation in a large extent.②Various factors for the adequate fixation of tibia and fibula fractures need to be considered,according to the fracture site, tibia and fibula fracture type, the degree of contamination and the degree of soft tissue injury.③Strictly implement and understanding of the AO and biological fracture fixation improvement theory is very important, A new range of steel plate and external fixator also worth for study and the application of the external fixator combined with limited internal fixation as well as the sequential therapy require further study with large amount samples. ④Arthroscopy or arthroplasty for severe cases of replace difficulties or joint injury can effectively improve fracture prognosis and postoperative life. The indirect reduction technique of percutaneous plate osteosynthesis indirect reduction can reduce the poor wound healing, infection, delayed union and nonunion, and it is gradually become the best choice for comminuted fracture of the distal tibia, while with the biological osteosynthesis principle designed locking compression plate equipment to make percutaneous plate osteosynthesis a worth to be promoted fixation technique.