胫骨髁塌陷裂骨折的手术治疗

目的探讨胫骨髁塌陷裂骨折的手术治疗方法。方法49例病人骨折按AO分类:44-B2型21例,44-B3型28例。其中合并韧带损伤19例,半月板损伤14例。均采用自体三面皮质髂骨块填充复位胫骨平台下方骨缺损以重建平台关节面,支撑钢板内固定治疗。合并韧带半月板损伤同期修复。在坚强内固定基础上,争取早期行CPM功能锻炼,8~10周后逐渐负重。结果随访2年以上,根据适用于一般膝关节损伤患者的功能评定方法标准,综合分析:优38例,良9例,尚可2例。结论利用三面皮质骨自体髂骨关节面下缺损处填充,既可充填骨缺损,又可构筑坚强的支持平台,保证了关节面的平整和高度;支撑钢板固定牢固,有利于早期功能锻炼,防止关节僵硬,使关节功能最大限度恢复,疗效显著。

Treatment of severe splitting and compressive tibial platean by grafting block of lilac bone to reconstract tibial plateu

Objective To investigatal the surgical treatment the sevrer splitting and compressive tibial plateau fractures.Methods Forty-nine patients with severe splitting and compressive tibial platean fractures were treated with block of lilac bone graft to reconstruct tiblal plateau and fixation with suppor tive plate.Accsrding to AO classification 21 patient type 44-B2,28 type 44-B3.After elerating of iliac graft was in serted horizon tally to artcular surface.Supporting plate was used for fixation.Functional training was practiced and waking loading was not exerted until 8-12 weeks after fixation.Results All the patients were follwed up 2 years.According to the standarda Wang yi-cong,the curative effect was excellent in 38 patients,good in 9 and fair in 2.Conclusions Block of iliac graft placed below the articular surface can not only fill the defect,but also insure the integrity and height of the articular surface and prevet re-xoilapsing.Supportive plate provides rigid fixation so the patients can pertorn function al exercises earlier,with weill prevent joint stiff,osteoporsis and reduce the incidence of arthritis.