锁定加压钢板桥接技术治疗粉碎性胫骨干骨折

目的 探讨锁定加压钢板(LCP)桥接技术治疗粉碎性胫骨干骨折的疗效。方法 2005年1月至2010年3月采用LCP治疗78例粉碎性胫骨干骨折患者，男46例，女32例；年龄23～ 69岁，平均36.4岁；左侧41例，右侧37例。骨折根据AO分型：均为42C型，其中C1型38例，C2型26例，C3型14例。闭合性骨折63例，开放性骨折15例。闭合性骨折待水肿消退后选用4.5或5.0mm LCP经皮桥接技术置入。开放性骨折经严格清创后同法置入LCP。术后鼓励患者进行屈髋、屈膝及下肢肌力训练。结果 78例患者术后获平均19个月（6～35个月）随访。所有患者无感染发生。骨折愈合时间平均为22周（13 ～42周）。77例患者获骨性愈合,1例因骨不连发生钢板断裂。末次随访时患者膝关节活动度为100°～130°，平均123°。膝关节功能按美国特种外科医院膝关节评分系统评分为89 ～96分，平均92.1分。踝关节功能按美国足踝外科学会制定的功能评分为82 ～97分，平均93.6分。结论 对于粉碎性胫骨干骨折，LCP桥接技术能提供可靠有效的内固定，并允许患者早期进行功能锻炼，是治疗粉碎性胫骨f骨折的有效方法之一。

Treatment of comminuted tibial shaft fractures using locking compression plating and bridging

Objective To evaluate clinical outcomes of locking compression plating (LCP) and bridging techniques for comminuted tibial shaft fractures.Methods From January 2005 to March 2010,78 patients with comminuted tibial shaft fractures were treated with LCP and bridging. They were 46 men and 32 women, with an average age of 36.4 years (from 23 to 69 years). There were 41 left and 37 right fractures. All the cases were of type 42C fracture according to AO classification, including 38 cases of C1, 26 cases of C2 and 14 cases of C3. Sixty-three cases were close and 15 cases were open fractures. For close fractures, a 4.5/5.0 mm LCP was inserted percutaneously with bridging technique after soft tissue swelling subsided, and the same surgical procedure was performed for open fractures after standard debridement. Hip and knee joint movements and muscle strength exercises of the affected lower extremity were encouraged for all patients after surgery.Results The average follow-up was 19 months (from 6 to 35 months). No cases suffered infection and fracture unions averaged 22 weeks (from 13 to 42 weeks) . Seventy-seven patients achieved bony consolidation, but one patient sustained hardware failure due to nonunion. The last follow-ups revealed the mean range of motion of the knee was 123° (from 100° to 130°), the mean Hospital for Special Surgery (HSS) score of the knee was 92.1 points (from 89 to 96 points) and the mean American Orthopaedic Foot and Ankle Society (AOFAS) score of the ankle was 93.6 points (from 82 to 97 points).Conclusion For a comminuted tibial shaft fracture, because intemal fixation with bridging LCP can lead to reliable stability and earlier rehabilitation for the patient, it is one of the optimal options.