吻合血管的髂骨瓣植骨联合锁定加压板固定治疗复杂胫骨平台骨折

目的探讨利用吻合血管的髂骨瓣植骨及锁定加压板固定治疗严重粉碎胫骨平台骨折的临床疗效。方法从2008年8月～2011年7月,对17例Ⅲ型(Schatzker分型)以上严重粉碎的胫骨平台骨折,采用吻合血管的髂骨瓣植骨及锁定加压板固定治疗。结果随访7～18个月(平均12.8个月),骨折均获愈合(平均7.5个月),无一例发生内固定松动、断裂或骨折复位丢失现象。术后6个月膝关节活动度平均为90°;根据膝关节HSS评分评定疗效:优7例,良6例,中4例,优良率为76.5%。结论吻合血管的髂骨瓣植骨不仅有效改善骨折端血运,还能提供有力的平台支撑,术后能早期进行功能锻炼,有利于促进骨质愈合;相比传统的单纯游离植骨治疗复杂胫骨平台,效果更加确实、可靠。

Treatment of complex tibial plateau fracture with vascularized iliac bone graft and locking compression plate

Objective To evaluate the clinical efficacy of vascularized iliac bone graft and locking compression plate in the treatment of complex tibial plateau fracture.Methods From Aug.2008 to Jul.2011,17 cases of complex tibial plateau fracture,which were type Ⅲ defined by Schatzker classification,were treated with vascularized iliac bone graft and locking compression plate.Results All patients were followed up for a mean duration of 12.8 months（range,7-18 months）.Bone union was observed in all cases after an average of 7.5 months.No loosening or rupture of the fixator,or reduction failure was observed.The mean range of knee joint motion was 90°.According to HSS scoring,there was excellent in 7 cases,good in 6 cases and fair in 4 cases,with excellent and good rate of 76.5%.Conclusion Vascularized iliac bone graft in the treatment of complex tibial plateau fracture can improve the blood supply and locking compression plate is an effective fixator due to its convenience and stability.The combined use of the two methods discussed above can achieve good clinical effects.