摘要
目的探讨胫骨远端干骺端骨折应用有限切开复位结合前外侧L形锁定加压接骨板（locking compression plate,LCP）内固定治疗的临床疗效。方法 2011年6月～2013年1月共收治15例胫骨远端干骺端骨折患者。骨折按照国际内固定研究协会（AO/ASIF）分型：43A2型3例,43A3型10例,43B1型2例,均合并腓骨下端骨折;胫骨远端干骺端骨折线距踝关节面1.6～4.5cm,平均2.8cm;闭合性骨折8例,开放性骨折7例（GustiloⅠ型2例,Ⅱ型3例,ⅢA型2例）。GustiloⅢA型2例急诊行清创、腓骨内固定及外固定支架固定,余患者术前行跟骨骨牵引。运用有限切开复位结合前外侧L形LCP内固定治疗,术中酌情植骨,术后早期功能锻炼。结果所有患者术后获12～18个月（平均16个月）随访,术后2例切口表皮坏死,经换药处理后愈合,余切口均一期愈合。骨折于术后16～24周（平均20周）获骨性愈合。末次随访时根据美国骨科协会足踝外科分会（American Orthopedic Foot Ankle Society,AOFAS）评分标准：评分为73～95分,平均89.5分,其中优10例,良3例,可2例,优良率86.7%。随访期间无感染、骨不连及内固定松动断裂等并发症发生。结论采用有限切开复位结合前外侧L形LCP内固定治疗胫骨远端干骺端骨折,术中利用微创置板技术,并酌情植骨,术后早期功能锻炼,可获得良好疗效。
Objective To investigate the clinical effects of limited open reduction and internal fixation with anterolateral L-shape locking compression plate for treatment of distal metaphyseal tibial fractures.Methods Fifteen patients with distal metaphyseal tibial fractures were treated in our department between Jun.2011 and Jan.2013.According to AO/ASIF classification,3 patients were with Type 43A2 fracture,10 patients with Type 43A3 fracture, 2 patients with Type 43B1 fracture and all were combined with lower fibula fractures.The distance from the fracture line of distal metaphyseal tibia to the ankle joint surface was 1.6-4.5cm （average 2.8cm）.There were 8 cases of closed fractures and 7 cases of open fractures（ Gustilo-Anderson Type I fracture in 2 cases,Type II in 3 cases,Type IIIA in 2 cases） .Two cases of Gustilo Type IIIA were treated by emergency debridement,internal fixation of fibula and external fixation,and others with calcaneal traction.Limited open reduction and internal fixation with anterolat-eral L-shape locking compression plate were performed,bone graft was performed in necessity and early exercise was encouraged after operation.Results All patients were followed up for 12-18 months（average 16 months）.Two cases developing epidermal necrosis after operation were healed by dressing;others were healed in the first stage. The fractures healed 20 （16-24 weeks） weeks after surgery.According to American Orthopaedic Foot and Ankle Society（AOFAS） score at the last follow-up,the mean score was 89.5（ranging from 73-95） points,and excellent re-sults were found in 10 patients,good in 3 and fair in 2.The excellent and good rate was 86.7%.No infection,bone nonunion and breakage of internal fixation complications occurred during the follow-up.Conclusion Limited open reduction and internal fixation with anterolateral L-shape locking compression plate for the treatment of distal me-taphyseal tibial fractures make use of minimally invasive plate technology with bone graft in necessity and early exer-cise after operation.It can obtain a good effect.
出处
《创伤外科杂志》
2015年第5期441-444,共4页
Journal of Traumatic Surgery
关键词
胫骨骨折
接骨板
内固定
tibial fracture
bone plate
internal fixation
