同种异体骨植骨加支撑钢板内固定治疗复杂胫骨平台骨折

目的探讨同种异体骨植骨加支撑钢板内固定治疗复杂胫骨平台骨折的方法及临床疗效。方法对16例复杂胫骨平台骨折患者全部采用同种异体骨植骨,并用支撑钢板稳定固定,术后根据韧带有无损伤早期结合CPM机行膝关节功能锻炼或石膏外固定。结果所有患者术后获10～62个月(平均38.2个月)随访,骨折均获骨性愈合,骨折愈合时间平均为4.5个月。膝关节功能参照Mechant评分标准,优9例,良5例,可2例,优良率为88%。结论对复杂胫骨平台骨折患者应严格评估软组织损伤程度及围手术期治疗,正确选择手术入路,解剖复位关节面的平整性,对骨折端予以坚强稳定的内固定,坚持生物学固定原则,骨缺损区行足量植骨并压实,有效修复交叉韧带、侧副韧带及半月板的损伤,避免术后胫骨平台发生Ⅱ期塌陷和膝关节机械轴的对线不良。

Treatment of complex tibial plateau fractures with bone allograft transplantation plus buttress plate internal fixation

Objective To explore the clinical effects of treating complex tibia] plateau fractures with bone allograft transplantation plus buttress plate internal fixation.Methods From June 2001 to October 2005 16 patients with complex tibial plateau fractures were surgically treated with bone allograft transplantation plus buttress plate internal fixation.Patients with operation-related injury of ligament were treated with plaster external fixation.Other patients were asked to exercise with CPM to recover knee joint function early after operation.Results All patients were followed up for 10-62 months with an average of 38.2 months.All patients achieved bone union,the duration of union averaged 4.5 months.Knee joint function was rated based on Mechant evaluation system as excellent in 9 cases,good in 5 eases and fair in 2 cases;the excellent and good rate was 88%.Conclusion For patients of complex tibial plateau frac- tures,strict evaluation of condition of soft tissue injury and the treatment of perioperation,accurate choice of approach,restoration of articular surface of plateau by anatomic reduction,rigid internal fixation,bio- logical fixation,ample bone transplant for bone defects,effective repair of cross ligaments,collateral liga- ments and meniscus injury,and avoidance of secondary compression of tibial plateau and malalignment of the machine axes of knee joint are very important factors of successful management.