锁定接骨板结合人工骨植骨治疗复杂胫骨平台骨折

目的探讨锁定接骨板内固定结合人工骨（由美国WRIGHT公司生产的MIIG115或X3）植骨治疗复杂胫骨平台骨折的临床疗效。方法2003年3月至2008年3月采取锁定接骨板内固定结合人工骨植骨治疗复杂胫骨平台骨折患者56例,男40例,女16例;年龄20～72岁,平均49.3岁。根据Schatzker分型：Ⅴ型32例,Ⅵ型24例。致伤原因：交通事故42例,摔伤11例,重物压伤3例。其中开放性损伤6例,包括GustiloⅠ度4例,Ⅱ度2例,合并半月板损伤3例,侧副韧带损伤7例,均未合并血管神经损伤,伤后至手术时间为5～21 d,平均7.9d。术后根据骨折类型及手术固定情况,早期在连续被动运动（continuous passive motion,CMP）机上行膝关节功能锻炼或石膏外固定。结果全部获得随访,随访时间3～26个月,平均14个月。56例均为骨性愈合,骨折愈合时间为3～9个月,平均4.5个月。根据Lysholm功能评价标准,优45例,良8例,可3例,优良率为94.6%。结论锁定接骨板内固定结合人工骨植骨治疗复杂胫骨平台骨折,可提供持续而稳固的固定,有效防止骨折再移位及膝关节力线的改变,避免术后胫骨平台发生塌陷,临床疗效满意。

Treatment of complex tibial plateau fractures with interlock plate internal fixation plus artificial bone

Objective To explore the clinical effects of Wright artificial bone transplantation plus interlock plate internal fixation on complex tibial plateau fractures.Methods From March 2003 to March 2008,56 patients with SchatzkerⅤ（n=32）orⅥ（n=24）tibial plateau fractures underwent Wright artificial bone transplantation plus interlock plate internal fixation.Of them,there were 40 males and 16 females with an average age of 49.3 years（ranged 20 to 72 years）.According to the type of fractures and the fixation in the operation,the patients were asked to exercise with CPM （continuous passive motion）machine to recover knee joint function early after operation or were performed external fixation with plaster.Results The average duration of follow-up was 14 months（ranged 8 to 26 months）.All the 56 patients achieved bone union and the average union duration was 4.5 months（ranged 3 to 9 months）.Knee joint function was assessed based on Lysholow score system as excellent in 45 cases,good in 8 and fair in 3.The excellent and good rate was 94.6%.Conclusion Wright artificial bone transplantation plus interlock plate internal fixation can provide a continuous and stable fixation for tibial plateau fractures,avoiding the replacement of fragments,change of the knee mechanics and a secondary compression of tibial plateau.Reliable clinical effect can be achieved for the tibial plateau fracture.