胫骨平台塌陷骨缺损的治疗现状及进展

胫骨平台塌陷骨折的特性决定了关节面必须解剖复位,胫骨力线必须恢复以及内固定必须坚强。在恢复关节面平整性的同时,关节面下骨缺损的处理却带来了许多难题。目前用于骨缺损治疗的材料归纳起来大致分3类:自体骨、同种异体骨和骨替代物。部分学者认为自体骨移植存在增加创伤、手术时间延长、来源有限、供骨区出血、持续疼痛与感觉麻木等缺点,但大多数学者认为目前治疗骨缺损的金标准仍是自体松质骨移植。同种异体骨移植存在免疫反应及病毒传染的可能,且因骨诱导特性受到破坏,移植骨力学特性和骨传导作用仍被保留。同样,骨替代物存在成骨与降解速率不匹配的问题。临床医生应根据患者自身的情况和经济状况选择符合需求的移植骨。

Current treatment situation and progress on bone defect of collapsed tibial plateau fractures

Characteristics of collapsed tibial plateau fracture determines that the joint surface must remain anatomical reduction,line of force in tibial must exist and internal fixation must be strong. However,while renewing articular surface smoothness,surgeons have a lot of problems in dealing with bone defect under the joint surface. Current materials used for bone defect treatment include three categories:autologous bone,allograft bone and bone substitutes. Some scholars think that autologous bone grafts have a number of drawbacks,such as increasing trauma,prolonged operation time,the limited source,bone area bleeding,continuous pain,local infection and anesthesia,but most scholars believe that the autologous cancellous bone graft is still the golden standard. Allograft bone has the ability of bone conduction,but the existence of immune responses,the possibility of a virus infection,and the limited source of the allograft cannot meet the clinical demands. Likewise,bone substitutes have the problem that osteogenesis does not match with degradation in rates. Clinical doctors can meet the demand of the patient's bone graft according to patient's own situation and economic conditions.