中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2013年
4期
663-671
,共9页
骨关节植入物%骨关节植入物综述%胫骨%腓骨%骨折%骨折部位%骨折类型%固定物%微创%稳定性%血液供应%研究进展
骨關節植入物%骨關節植入物綜述%脛骨%腓骨%骨摺%骨摺部位%骨摺類型%固定物%微創%穩定性%血液供應%研究進展
골관절식입물%골관절식입물종술%경골%비골%골절%골절부위%골절류형%고정물%미창%은정성%혈액공응%연구진전
bone and joint implants%review of bone and joint implants%tibia%fibula%fracture%fracture site%fracture type%fixation%minimal y invasive%stability%blood supply%research progress
背景:研究表明,血液供应和坚强牢固的骨折内固定存在不少冲突.胫骨和腓骨骨折患者手术治疗时人工内植物固定方式的选择,业已成为一个迫切需要解决的临床课题.目的:回顾近年来不同类型胫骨和腓骨骨折固定物及固定方式的文献研究,为胫骨和腓骨骨折临床治疗实践中客观合理地选择固定物提供参考和评价标准.方法:计算机检索 PubMed 数据库和中国期刊全文数据库(CNKI)于1990年1月至2012年5月有关胫腓骨骨折手术固定治疗的临床与基础实验研究,检索关键词分别为“tibiofibular fracture, fixation method, research progress”和“胫腓骨骨折,固定方法,研究进展”,排除发表时间较早或重复研究.结果与结论:①胫骨和腓骨拥有自己独特的解剖结构和生理功能,骨折固定稳定及血液供应保障,应在胫骨和腓骨骨折的治疗中首先考虑,手术之后早期进行功能锻炼是骨折恢复所必要的过程,也将很大程度上依赖骨折固定的稳定性.②以何种方式固定胫骨和腓骨骨折,应根据骨折部位、骨折类型、创伤污染程度、软组织损伤程度等多种因素决定.③严格执行经典 AO 骨折的固定和生物骨折固定的改良理论和技术显得非常重要.新型系列钢板和外固定支架的出现亦是值得研究的临床方向,外固定支架结合有限内固定的使用以及序贯治疗概念的提出有待进一步大样本实践研究.④解剖复位困难或严重损害邻近关节的特殊病例,关节镜或关节置换可以有效地提高骨折的预后并改善术后生活功能.通过经皮插入钢板内固定间接复位技术,降低了伤口愈合不良、感染、骨折延迟愈合、骨不连等不良后果的发生率,正逐渐成为胫骨远端粉碎性骨折的最佳选择,而配合符合生物学骨折内固定原则的锁定加压钢板器械设计使经皮插入钢板内固定得以成为值得推广的内固定技术.
揹景:研究錶明,血液供應和堅彊牢固的骨摺內固定存在不少遲突.脛骨和腓骨骨摺患者手術治療時人工內植物固定方式的選擇,業已成為一箇迫切需要解決的臨床課題.目的:迴顧近年來不同類型脛骨和腓骨骨摺固定物及固定方式的文獻研究,為脛骨和腓骨骨摺臨床治療實踐中客觀閤理地選擇固定物提供參攷和評價標準.方法:計算機檢索 PubMed 數據庫和中國期刊全文數據庫(CNKI)于1990年1月至2012年5月有關脛腓骨骨摺手術固定治療的臨床與基礎實驗研究,檢索關鍵詞分彆為“tibiofibular fracture, fixation method, research progress”和“脛腓骨骨摺,固定方法,研究進展”,排除髮錶時間較早或重複研究.結果與結論:①脛骨和腓骨擁有自己獨特的解剖結構和生理功能,骨摺固定穩定及血液供應保障,應在脛骨和腓骨骨摺的治療中首先攷慮,手術之後早期進行功能鍛煉是骨摺恢複所必要的過程,也將很大程度上依賴骨摺固定的穩定性.②以何種方式固定脛骨和腓骨骨摺,應根據骨摺部位、骨摺類型、創傷汙染程度、軟組織損傷程度等多種因素決定.③嚴格執行經典 AO 骨摺的固定和生物骨摺固定的改良理論和技術顯得非常重要.新型繫列鋼闆和外固定支架的齣現亦是值得研究的臨床方嚮,外固定支架結閤有限內固定的使用以及序貫治療概唸的提齣有待進一步大樣本實踐研究.④解剖複位睏難或嚴重損害鄰近關節的特殊病例,關節鏡或關節置換可以有效地提高骨摺的預後併改善術後生活功能.通過經皮插入鋼闆內固定間接複位技術,降低瞭傷口愈閤不良、感染、骨摺延遲愈閤、骨不連等不良後果的髮生率,正逐漸成為脛骨遠耑粉碎性骨摺的最佳選擇,而配閤符閤生物學骨摺內固定原則的鎖定加壓鋼闆器械設計使經皮插入鋼闆內固定得以成為值得推廣的內固定技術.
배경:연구표명,혈액공응화견강뢰고적골절내고정존재불소충돌.경골화비골골절환자수술치료시인공내식물고정방식적선택,업이성위일개박절수요해결적림상과제.목적:회고근년래불동류형경골화비골골절고정물급고정방식적문헌연구,위경골화비골골절림상치료실천중객관합리지선택고정물제공삼고화평개표준.방법:계산궤검색 PubMed 수거고화중국기간전문수거고(CNKI)우1990년1월지2012년5월유관경비골골절수술고정치료적림상여기출실험연구,검색관건사분별위“tibiofibular fracture, fixation method, research progress”화“경비골골절,고정방법,연구진전”,배제발표시간교조혹중복연구.결과여결론:①경골화비골옹유자기독특적해부결구화생리공능,골절고정은정급혈액공응보장,응재경골화비골골절적치료중수선고필,수술지후조기진행공능단련시골절회복소필요적과정,야장흔대정도상의뢰골절고정적은정성.②이하충방식고정경골화비골골절,응근거골절부위、골절류형、창상오염정도、연조직손상정도등다충인소결정.③엄격집행경전 AO 골절적고정화생물골절고정적개량이론화기술현득비상중요.신형계렬강판화외고정지가적출현역시치득연구적림상방향,외고정지가결합유한내고정적사용이급서관치료개념적제출유대진일보대양본실천연구.④해부복위곤난혹엄중손해린근관절적특수병례,관절경혹관절치환가이유효지제고골절적예후병개선술후생활공능.통과경피삽입강판내고정간접복위기술,강저료상구유합불량、감염、골절연지유합、골불련등불량후과적발생솔,정축점성위경골원단분쇄성골절적최가선택,이배합부합생물학골절내고정원칙적쇄정가압강판기계설계사경피삽입강판내고정득이성위치득추엄적내고정기술.
BACKGROUND: Studies have shown that there is a controversy between blood supply and the fast fracture fixation. Selection of the suitable fixation method for the patients with tibia and fibula fracture is the important issue in face of every clinician. OBJECTIVE: To review various types of research literatures on tibia and fibula fracture fixation in recent years, in order to provide reference and evaluation criteria for objective and reasonable selection of tibia and fibula fracture fixation method. METHODS: A computer-based online search was performed in the PubMed database and the China National Knowledge Infrastructure database for the clinical and basic experimental research papers on the surgical fixation of tibia and fibula fracture from January 1990 to May 2012. The key words were “tibiofibular fracture, fixation method, research progress” in Chinese and English. The articles published earlier and repetitive researches were excluded. RESULTS AND CONCLUSION: ①Due to the special anatomy structure and physiologic function of tibia and fibula, the first step in the treatment of the fracture is to consider how to balance the blood supply and stability, and the functional exercise must be practiced as soon as possible after fixation, which wil rely on a stable fixation in a large extent. ②Various factors for the adequate fixation of tibia and fibula fractures need to be considered, according to the fracture site, tibia and fibula fracture type, the degree of contamination and the degree of soft tissue injury. ③Strictly implement and understanding of the AO and biological fracture fixation improvement theory is very important. A new range of steel plate and external fixator also worth for study and the application of the external fixator combined with limited internal fixation as wel as the sequential therapy require further study with large amount samples. ④Arthroscopy or arthroplasty for severe cases of replace difficulties or joint injury can effectively improve fracture prognosis and postoperative life. The indirect reduction technique of percutaneous plate osteosynthesis indirect reduction can reduce the poor wound healing, infection, delayed union and nonunion, and it is gradual y become the best choice for comminuted fracture of the distal tibia, while with the biological osteosynthesis principle designed locking compression plate equipment to make percutaneous plate osteosynthesis a worth to be promoted fixation technique.
