EH型复合材料在胫骨平台骨折中的初步应用

手术治疗１２例有移位的胫骨平台骨折，复位后用ＥＨ型复合材料人工骨填塞干骺端缺损，术后平均随访１２个月，经Ｘ线片和临床评价表明，ＥＨ型复合材料人工骨对自体松质骨移植治疗胫骨平台骨折而言是一各安全的和有效的替代物。     

万向锁定钢板结合WRIGHT人工骨植骨技术治疗Schatzker Ⅱ型胫骨平台骨折

目的探讨万向锁定钢板结合WRIGHT人工骨植骨技术治疗Schatzker Ⅱ型胫骨平台骨折的临床疗效。方法10例Schatzker Ⅱ型胫骨平台骨折患者采取万向锁定钢板结合WRIGHT人工骨植骨技术治疗,术后根据骨折类型及固定情况,早期结合CPM机行膝关节功能锻炼。结果患者均获随访,时间7～19（11.8±3.71）个月。骨折愈合时间2.5～4.3（3.5±0.64）个月。参照Lysholow功能评价标准：优4例,良6例。结论万向锁定钢板结合WRIGHT人工骨植骨为胫骨平台骨折提供了持续稳定的固定,避免了骨块的移位和平台的再次压缩,治疗Schatzker Ⅱ型胫骨平台骨折疗效可靠。     

关节镜下辅助复位注射人工骨治疗胫骨平台SchatzkerⅢ型骨折

[目的]观察关节镜辅助下复位,使用可注射人工骨治疗胫骨平台SchatzkerⅢ型骨折的临床疗效。[方法]采用关节镜下关节腔探查,直视下胫骨平台塌陷骨折复位,可注射人工骨平台下成形治疗胫骨平台SchatzkerⅢ型骨折患者9例,均为闭合骨折,其中合并半月板损伤3例,合并前交叉韧带止点撕脱2例。[结果]9例患者随访24～60个月,平均45个月,术后关节功能评价参照Rasmussen评分标准:优8例,良1例。[结论]关节镜下辅助复位,注射人工骨治疗胫骨平台SchatzkerⅢ型骨折,具有创伤小,复位准确,植骨充分、稳定,关节功能恢复良好,并发症少等优点,是一种治疗胫骨平台SchatzkerⅢ型骨折较理想的方法。     

硫酸钙人工替代骨加解剖钢板内固定治疗胫骨平台塌陷骨折

目的：探讨可注射硫酸钙人工骨加解剖钢板内固定治疗胫骨平台塌陷骨折的临床效果。方法：采用切开复位、可注射硫酸钙人工骨加解剖型钢板内固定的方法治疗胫骨平台骨折23例。结果：随访6～15个月,治疗效果参照Rasmussen的评分标准,优13例,良7例,可2例,差1例,优良率87%。结论：可注射流酸钙人工骨加解剖钢板内固定治疗胫骨平台塌陷骨折效果良好。     

人工骨植骨可吸收螺钉内固定治疗胫骨平台Ⅱ、Ⅲ型骨折

目的探讨治疗胫骨平台Ⅱ、Ⅲ型(Schatzker分型)骨折的一种新方法。方法对18例胫骨平台Ⅱ、Ⅲ型骨折行切开复位人工骨植骨可吸收螺钉内固定,术后适当的外固定及功能锻炼。结果经平均10·5个月随访,按膝关节功能评定标准评定:优16例(89%),良2例(11%)。结论对于胫骨平台Ⅱ、Ⅲ型骨折行人工骨植骨可吸收螺钉内固定治疗,可获得满意的疗效,具有减轻患者痛苦,避免第二次手术取内固定物的优点。     

锁定钢板结合BAM人工骨治疗胫骨平台粉碎性骨折

目的评价应用锁定钢板结合生物活性陶瓷(BAM)骨诱导人工骨植骨治疗胫骨平台粉碎性骨折的疗效。方法对26例胫骨平台粉碎性骨折均采用锁定钢板内固定并植入BAM骨诱导人工骨填充骨折复位后的骨缺损。结果本组均获随访9~12个月,术后疗效按Rasmussen评分标准评价优良率达92.3%。结论锁定钢板结合BAM骨诱导人工骨植骨治疗胫骨平台粉碎性骨折可获得满意临床疗效,值得推广应用。     

复杂胫骨平台骨折的手术治疗

目的探讨复杂胫骨平台骨折的手术治疗方法。方法自2005年1月至2007年6月共收治36例复杂胫骨平台骨折患者,男24例,女12例;年龄21～68岁,平均42岁。按Schatzker分型：Ⅳ型,胫骨内髁骨折8例;V型,双髁骨折15例;VI型,外侧髁伴有干骺端与骨干分离的平台骨折13例。采用胫骨近端解剖支持钢板内固定、同种异体骨植骨和早期被动关节功能锻炼治疗。结果32例获得随访,随访时间1-2．5年,参照Merchant功能评定标准：优18例,良9例,中3例,差2例,优良率85％。结论胫骨近端解剖支持钢板内固定结合同种异体骨植骨治疗复杂胫骨平台骨折的骨折复位满意,关节面平整,内固定坚强,可早期功能锻炼,疗效满意,被认为是理想的治疗方法。     

关于胫骨平台骨折的手术治疗体会(附37例报告)

[目的]探讨胫骨平台骨折的手术治疗方法。[方法]对37例胫骨平台骨折患者行切开复位内固定，Schatzker分类Ⅱ型、Ⅲ型、Ⅳ型者同时予以植骨。[结果]37例随访12～36个月，平均17个月。按Merchant评分标准，优良率86．5％。[结论]对移位的胫骨平台骨折宜采用切开复位适当的内固定术，Ⅱ型和Ⅲ型、Ⅳ型患者应予植骨。     

经皮撬拨复位人工骨注入治疗老年胫骨平台压缩骨折

目的:观察应用经皮撬拨复位结合固化磷酸钙人工骨注入治疗老年胫骨平台压缩骨折的临床疗效.方法:老年人胫骨平台压缩骨折27例,采用有限切口撬拨复位结合固化磷酸钙骨水泥注入治疗.结果:骨折均在12周内愈合.按Sander膝关节评分法评估疗效,优20例,良6例,可1例.结论:经皮撬拨复位结合磷酸钙人工骨注入是治疗老年胫骨平台压缩骨折的理想方法.     

关节镜监视下微创经皮钢板固定治疗老年胫骨平台骨折

目的探讨关节镜监视下采用微创技术治疗胫骨平台骨折的疗效。方法自2004年4月~2005年11月,在关节镜监视下利用微创技术骨折复位、人工骨植骨,经皮插入钢板治疗老年胫骨平台骨折11例。结果术后随访6~18个月,骨折均愈合,平均3·6个月,无感染及皮肤坏死,无骨不连等严重并发症。结论关节镜监视下微创经皮骨折复位,钢板固定并人工骨植骨治疗老年胫骨平台骨折,手术创伤小、骨折复位直观、满意,固定可靠。     

Interporous hydroxyapatite as a bone graft substitute in tibial plateau fractures

The metaphyseal defects in 40 patients with displaced tibial plateau fractures necessitating surgical repair were filled with either cancellous autograft or interporous hydroxyapatite. Roentgenographic and clinical assessments at follow-up periods averaging 15.4 months (autograft) and 34.5 months (hydroxyapatite) demonstrated no significant differences in the two groups. Interporous hydroxyapatite is a safe, effective alternative to autogenous cancellous bone for the filling of metaphyseal defects associated with tibial plateau fractures.     

An injectable calcium phosphate cement as a bone-graft substitute in the treatment of displaced lateral tibial plateau fractures

In the treatment of displaced tibial plateau fractures, filling the resultant metaphyseal defect is essential for maintaining reduction. This study reports on 14 patients with an average age of 53 (range 34-63) years who sustained such a fracture and whose tibial defect was augmented with an injectable calcium phosphate cement under arthroscopic and fluoroscopic control. Eight fractures were treated with subcortical percutaneous screw fixation, plates were used in four cases and two fractures were treated with bone cement only. Full weight-bearing was allowed after 6-12 weeks. At the last follow-up which averaged 28 (range 18-47) months, the reduction achieved at the index operation was not altered in any of the patients except one. Most patients recorded little or no pain with an average VAS score of 1.2 (0-3.4). Ten patients had no limitation of their walking distance. Patient satisfaction was good or excellent in 12 cases. Flexion averaged 140 degrees (range 130-150 degrees ) and extension was unlimited in 13 patients. The Lysholm knee score averaged 80 and the Knee Society score 180 (range 127-195). In our opinion the injectable calcium phosphate cement used here is a promising alternative for filling metaphyseal defects in the treatment of displaced tibial plateau fractures.     

自体富血小板血浆与人工骨混合物治疗胫骨平台骨折合并骨缺损的临床应用

背景：骨缺损修复一直是骨科临床面临的难题之一。近年来,骨组织工程学的发展为骨缺损修复开辟了新的途径,但骨髓基质细胞体外培养回植入体内修复骨缺损还仅限于实验研究。目的：评价临床上应用自体富血小板血浆（PRP）与人工骨混合物治疗胫骨平台骨折合并骨缺损的临床疗效。方法：2006年7月至2010年7月收治胫骨平台骨折合并骨缺损患者（SchatzkerⅡ~Ⅴ型）36例。随机分成：A组（17例）采用自体PRP与人工骨复合物填充骨缺损;B组（19例）采用自体髂骨填充。所有患者于术后1.5、3、6、12个月复查植骨部位的X线片观察骨折愈合时间,采用Rasmussen评分标准评价胫骨平台骨折复位及固定效果,Hss评分评价膝关节术后功能恢复情况,NRS分级法对疼痛进行量化评分,配对T检验对两组数据进行比较。结果：36例全部获得随访,随访时间11-36个月,平均16个月。A组患者平均手术时间、术中出血量及术后疼痛评分（不包括供骨区）明显低于B组（P〈0.05）,而Rasmussen评分、HSS评分及骨折平均愈合时间与B组无明显差异（P〉0.05）。结论：自体PRP与人工骨混合物填充治疗胫骨平台骨折合并骨缺损较传统自体髂骨填充显著缩短手术时间,减少术中出血,减轻术后疼痛,避免供骨区并发症,修复效果理想,为胫骨平台骨折合并骨缺损的治疗提供了一个新的方法。     

Die Anwendung des injizierbaren Knochenzements Norian SRS bei Tibiakopffrakturen

Reduction of the depressed joint surface in tibial plateau fractures often leaves large cancellous bone defects. These metaphyseal voids are typically filled with autogenous bone grafts that can cause a significant donor site morbidity. The use of injectable bone cement offers the opportunity to support the reduced joint surface without bone grafting. The aim of this study was to evaluate the clinical and radiological outcome as well as the period of partial weight bearing after the use of Norian SRS in tibial plateau fractures. Twenty-one patients with a mean age of 48 years were included in this prospective trial. According to the AO/OTA Classification, there were seven fractures of type B2, ten B3, one C1, one C2, and two fractures of type C3. The period of partial weight bearing was 3.7 weeks. In 18 patients the follow-up was more than 24 months. After a mean follow-up of 30 months, the Lysholm score was 87.9 at mean. The radiological part of the Rasmussen score was excellent and good in eight cases each and fair in four cases. Soft tissue reactions due to the cement were not observed. On all radiographs taken 36 months after the operation the cement bloc was still visible. The results show that Norian SRS can be used to fill metaphyseal bone defects in tibial plateau fractures. Clinical and radiological results are comparable to those of fractures treated with autologous bone graft. The high compression strength allows early full weight bearing without the risk of secondary loss of reduction.     

Percutaneous inflation osteoplasty for indirect reduction of depressed tibial plateau fractures

Anatomic reduction of articular depression tibial plateau fractures is challenging. The authors describe a new technique using percutaneous balloon-guided inflation osteoplasty for a depressed lateral tibial plateau fracture. The fluoroscopy-guided inflation osteoplasty restores the joint surface anatomically in a minimally invasive fashion. The metaphyseal void is filled with a fast-setting fluid-phase bone substitute, and a lateral buttress plate is applied with less invasive incisions. This technique is a valid alternative for indirect reduction of depressed articular tibial plateau fractures.     

截骨复位治疗胫骨外侧平台压缩性骨折

目的探讨胫骨外侧平台压缩性骨折的治疗方法。方法 2002年1月至2008年12月采用截骨复位、植骨内固定治疗胫骨平台压缩性骨折32例。结果 32例患者获得12～24个月随访,平均随访时间15个月。随访12个月膝关节功能按Rasmussen标准评分,优21例,良9例,可2例,优良率达93.8%。比较术后即刻与随访12个月时胫骨平台塌陷高度、增宽宽度及外倾角,差异无统计学意义（P〉0.05）。无螺钉松动、断裂及内固定失败等并发症发生。结论截骨复位法治疗胫骨外侧平台压缩性骨折,具有直视下易于将关节面整复到正常形态和高度、术中形成骨缺损区域小、植骨量少以及易于植入和植实等优点,尤其对于平台边缘有压缩性骨折及伴有胫骨平台增宽的病例,这种手术方法更具实用性。     

Use of a biphasic cement bone substitute in the management of metaphyseal fractures

ObjectivesIn recent years, the increase in utilisation of bone substitutes in the reconstruction of bone defects has been fuelled by donor site complications associated with autologous bone harvesting. However the ability of bone substitute to stimulate bone union while maintaining fracture reduction has been a topic of debate. Cerament Bone Void Filler (CBVF) is a novel biphasic and injectable ceramic bone substitute that has high compressive strength and the ability to promote cancellous bone healing.Materials and MethodThis is a retrospective study to evaluate the surgical outcome of utilising CBVF in the treatment of depressed metaphyseal bone fractures over a two year period. The patients were followed up for at least six months after surgery and clinical parameters such as wound site complications were collated. Radiographic imaging was evaluated to determine loss of fracture reduction and rate of cement resorption.ResultsThirteen patients with depressed metaphyseal fractures were enrolled, which included: (i) one proximal humerus fracture; (ii) three tibial plateau fractures; and (iii) nine calcaneal fractures. None of the patients showed significant collapse in fracture reduction after six months of follow up. Cement resorption was noted in one patient as early as three weeks after surgery. There were no cases of cement leak or wound site complications.ConclusionCerament Bone Void Filler (CBVF) is a promising bone graft substitute in the management of depressed metaphyseal bone fractures, with the ability to maintain fracture reduction despite cement resorption.     

Outcome of raft plate fixation of split depressed tibial plateau fracture without using a bone graft

Schatzcker type 3 tibial plateau fractures are common intra-articular injuries. These fractures can be associated with significant depression of articular surface, usually requiring open reduction, elevation of articular surface and rigid internal fixation. The resultant metaphyseal defect is filled with either cancellous autografts (Lachiewicz in Clin Orthop Relat Res 259:210–215, 1990) allografts or calcium phosphates to maintain the reduction. Percutaneous fixation (Koval in J Orthop Trauma 6:340–346, 1992) and ring fixators have been used to stabilize these fractures. Autogenous bone-graft harvesting is associated with significant morbidity with reported major complication rate of 8.6% and minor complication rate of 20.6% and there is a limited availability for larger defects. Allografts and bone substitutes are associated with their own problems (Segur in Arch Orthop Trauma Surg 117(6,7):357–359, 1998). The purpose of this study was to review the outcome of split depressed tibial plateau fractures treated by open reduction and internal fixation using subchondral raft plate fixation without the use of bone graft.     

Joint depression in tibial plateau fractures: To bone graft or not to bone graft?

Tibial plateau fractures with significant joint depression and metaphyseal comminution pose a challenge. In order to prevent the collapse of the articular surface, some authors propose filling the subchondral void created during reduction with bone graft/substitute, which can add further complications. We present two cases of tibial plateau fractures with severe joint depression of the lateral condyle; both treated with a periarticular rafting construct, in one caseadditional bone substitute was used and in the other case no bone graft/substitute was used; their final outcomes were reported. The treatment of joint depression in tibial plateau fractures using periarticular rafting constructs without bone graft, may be also a valid option, to achieve good final results without the morbidity associated with the use of bone graft/substitutes.     

Interference Screw Technique for Arthroscopic Reduction and Internal Fixation of Compression Fractures of the Tibial Plateau

Arthroscopic reduction and internal fixation (ARIF) is recommended as state-of-the-art treatment for patients with pure compression fracture of the tibial plateau. We describe a new technique for ARIF of pure compression tibial plateau fractures that uses a cannulated, bioabsorbable interference screw. After a guide pin is placed in the center of the compressed fragment and a tamp is used to elevate the fracture (with bone grafting as desired), the interference screw is advanced over the guide pin, resulting in both elevation and buttressing of the fracture. As compared with previously described techniques in which percutaneous buttress screws were used, ARIF attained with an interference screw via the tibial metaphyseal window allows substantially improved efficiency of surgical steps, improved preservation of the soft tissue envelope, definitive articular reduction under arthroscopic visualization, use of a bioabsorbable implant, and elimination of the need for fluoroscopy.