| 章建卫,孟乘飞,陈榆,等.锁定加压钢板个体化治疗胫骨平台双柱或三柱骨折.骨科,2015,6(5): 252-255,260. |
| 锁定加压钢板个体化治疗胫骨平台双柱或三柱骨折 |
| Individualized use of a locking compression plate for tibial plateau bi- or tri-column fracture |
| 投稿时间：2015-02-01 |
| DOI：10.3969/j.issn.1674-8573.2015.05.009 |
| 中文关键词: 胫骨骨折 骨折固定术，内 治疗结果 |
| 英文关键词: Tibial fractures Fracture fixation, internal Treatment outcome |
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| 中文摘要: |
| 目的 探讨锁定加压钢板（locking compression plate，LCP）治疗不同损伤程度的双柱或三柱胫骨平台骨折的疗效。方法 2010年6月至2013年6月，依据骨折粉碎、分离移位的严重程度及软组织条件对广州军区武汉总医院骨科52例胫骨平台损伤患者个体化选择适当的内固定进行治疗，其中30例患者应用单侧LCP固定；17例患者应用内、外双侧钢板固定；5例患者应用内、外、后侧三钢板支撑固定。术后定期复查X线片，依据骨折愈合的情况，指导患者行渐进性功能锻炼。采用美国特种外科医院（American hospital for special surgery，HSS）膝关节功能评分标准评定术后膝关节功能；采用Rasmussen膝关节放射学评分法评估术后影像学表现。结果 本组患者术后获得随访6～22个月（平均12个月），无骨折再移位及螺钉松动、内固定失效等并发症发生。52例均获临床愈合，愈合时间为术后12～16周。4例患者于术后3 d出现切口渗液现象，细菌培养为阴性，考虑为脂肪液化所致，经换药治疗后渗液消失。1例患者发生慢性骨髓炎，后经换药、清创治愈。HSS评分优良率为86.5%；术后Rasmussen放射学评分为13.0～18.0分，平均16.3分。结论 对于不同损伤程度的累及双柱或三柱的复杂胫骨平台骨折，术前应明确骨折的损伤情况，制定良好的手术方案，突出个体化治疗，采用单侧、双侧或三侧LCP固定，可获得满意疗效。 |
| 英文摘要: |
| Objective To investigate the application of a locking compression plate (LCP) in treating different degrees of bi- or tri-column tibial plateau fracture. Methods From Jun. 2010 to Jun. 2013, 52 patients with tibial plateau fractures underwent individualized internal fixation in our hospital according to the severity of comminution, separation, and displacement, as well as soft tissue conditions. Of these, 30 underwent unilateral LCP fixation, 17 underwent interior and exterior bicortical plate fixation, and 5 underwent interior, exterior, and posterior tricortical plate fixation. Regular postoperative X-rays were performed to guide the patients in progressive functional exercises, based on the status of fracture healing. The scoring standard of the American Hospital for Special Surgery (HSS) was used to assess postoperative knee function. The Rasmussen knee radiology scoring method was used to assess postoperative radiographic images. Results The patients in this study were followed up for 6-22 months (mean 12 months). There were no complications, such as fracture re-displacement, screw loosening, interior fixation failure, etc. The 52 patients achieved clinical fracture healing within 12-16 weeks after surgery. Four patients developed an incision effusion 3 days after surgery, and the bacterial culture results were negative, suggesting fat liquefaction. The exudate resolved with dressings. One patient developed chronic osteomyelitis, which resolved with dressing and debridement. The rate of excellent HSS scores was 86.5%. Postoperative Rasmussen radiological scores were 13.0-18.0 points, with an average of 16.3. Conclusion Different degrees of injury involving bi- or tri-column complex tibial plateau fractures should be identified preoperatively, and a surgical program emphasizing individualized therapy, with the application of unilateral, bilateral, or trilateral LCP fixation, could achieve satisfactory results. |
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