CAJ | 학술논문

目的探讨钢板结合髓内钉治疗同侧胫骨平台单髁伴胫骨干中、远段骨折的可行性和临床疗效.方法 2003年5月至2008年11月,钢板结合髓内钉固定治疗胫骨平台单髁伴同侧胫骨干骨折21例,男15例,女6例;年龄20～55岁,平均34岁.按Schatzer分类,Ⅰ型4例、Ⅱ型11例、Ⅲ型6例.胫骨干骨折按部位分型,胫骨干中段骨折13例、中下1/3骨折8例.复位后,先钢板固定胫骨平台再髓内钉固定胫骨干19例,先髓内钉固定胫骨干再钢板固定胫骨平台2例.结果所有病均例获得随访,随访时间0.9～4年,平均2.2年.所有患者均获骨性愈合,胫骨平台平均愈合时间为12周;胫骨干骨折平均愈合时间为29周,3例患者胫骨干骨折延迟愈合,拆除交锁钉使之动力化后愈合.1例胫骨平台未能解剖复位导致骨折畸形愈合.根据HSS膝关节评分标准[2],优17例(80.95％)、良3例(14.29％)、中1例(4.76％).结论注意一些技术要点,应用两种熟悉的手术技巧,钢板结合髓内钉能够成功治疗胫骨平台单髁伴同侧胫骨干骨折.
목적 탐토강판결합수내정치료동측경골평태단과반경골간중、원단골절적가행성화림상료효.방법 2003년5월지2008년11월,강판결합수내정고정치료경골평태단과반동측경골간골절21례,남15례,녀6례;년령20～55세,평균34세.안Schatzer분류,Ⅰ형4례、Ⅱ형11례、Ⅲ형6례.경골간골절안부위분형,경골간중단골절13례、중하1/3골절8례.복위후,선강판고정경골평태재수내정고정경골간19례,선수내정고정경골간재강판고정경골평태2례.결과 소유병균례획득수방,수방시간0.9～4년,평균2.2년.소유환자균획골성유합,경골평태평균유합시간위12주;경골간골절평균유합시간위29주,3례환자경골간골절연지유합,탁제교쇄정사지동력화후유합.1례경골평태미능해부복위도치골절기형유합.근거HSS슬관절평분표준[2],우17례(80.95％)、량3례(14.29％)、중1례(4.76％).결론 주의일사기술요점,응용량충숙실적수술기교,강판결합수내정능구성공치료경골평태단과반동측경골간골절.
Objective To analyze the feasibility and effect of combining intramedullary nails and plates in the treatment of ipsilateral unicondylar tibial plateau fractures with non.contiguous tibial shaft fractures.Methods From May 2003 to November 2005,21 patients with ipsilateral unicondylar tibial plateau fracture and non-contiguous tibial shaft fracture were treated with combining intramedullary nails and plates,including 15 males and 6 females,with the mean age of 34 years (range,20-55 years).The tibial plateau fractures were classified according to Schatzker et al.; 4 cases were type Ⅰ,11 cases type Ⅱ,6 cases type Ⅲ and 1 case type Ⅵ.Middle third tibial shaft fractures were in 13 patients,and distal third tibial shaft fractures were in 8 patients.Once the reduction was obtained,we first fixed tibial plateau with plate and then tibial shaft with medullary nail in 19 cases; in 2 cases,we first fixed the tibial shaft with medullary nail and then tibial plateau with plate.Results 1All patients were followed up for 0.9 to 4 years (average,2.2 years).Bone union was obtained in all patients.The tibial plateau fractures united after an average of 12 weeks,and the tibial shaft fractures united after an average of 29 weeks.Delayed union of the tibial shaft fracture occurred in 3 patients,and the fracture healed finally by removing the proximal locking.Tibial plateau malunion occurred in one patient due to malreduction.According to HSS scores,excellent result was obtained in 17 patients (80.95％),good in 3 patients (14.29％),fair in 1 patient (4.76％).Conclusion With careful attention to some techniques,ipsilateral unicondylar tibial plateau fractures with non-contiguous tibial shaft fractures can be treated successfully by combining medullary nail and plate.