骨科
骨科
골과
Orthopaedics
2015年
5期
252-255,260
,共5页
章建卫%孟乘飞%陈榆%刘曦明%钟永翔
章建衛%孟乘飛%陳榆%劉晞明%鐘永翔
장건위%맹승비%진유%류희명%종영상
胫骨骨折%骨折固定术,内%治疗结果
脛骨骨摺%骨摺固定術,內%治療結果
경골골절%골절고정술,내%치료결과
Tibial fractures%Fracture fixation%internal%Treatment outcome
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3d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.
目的 探討鎖定加壓鋼闆(locking compression plate,LCP)治療不同損傷程度的雙柱或三柱脛骨平檯骨摺的療效. 方法 2010年6月至2013年6月,依據骨摺粉碎、分離移位的嚴重程度及軟組織條件對廣州軍區武漢總醫院骨科52例脛骨平檯損傷患者箇體化選擇適噹的內固定進行治療,其中30例患者應用單側LCP固定;17例患者應用內、外雙側鋼闆固定;5例患者應用內、外、後側三鋼闆支撐固定. 術後定期複查X線片,依據骨摺愈閤的情況,指導患者行漸進性功能鍛煉. 採用美國特種外科醫院( American hospital for special surgery,HSS)膝關節功能評分標準評定術後膝關節功能;採用Rasmussen膝關節放射學評分法評估術後影像學錶現. 結果 本組患者術後穫得隨訪6~22箇月(平均12箇月) ,無骨摺再移位及螺釘鬆動、內固定失效等併髮癥髮生. 52例均穫臨床愈閤,愈閤時間為術後12~16週.4例患者于術後3d齣現切口滲液現象,細菌培養為陰性,攷慮為脂肪液化所緻,經換藥治療後滲液消失. 1例患者髮生慢性骨髓炎,後經換藥、清創治愈. HSS評分優良率為86. 5%;術後Rasmussen放射學評分為13. 0~18. 0分,平均16. 3分. 結論 對于不同損傷程度的纍及雙柱或三柱的複雜脛骨平檯骨摺,術前應明確骨摺的損傷情況,製定良好的手術方案,突齣箇體化治療,採用單側、雙側或三側LCP固定,可穫得滿意療效.
목적 탐토쇄정가압강판(locking compression plate,LCP)치료불동손상정도적쌍주혹삼주경골평태골절적료효. 방법 2010년6월지2013년6월,의거골절분쇄、분리이위적엄중정도급연조직조건대엄주군구무한총의원골과52례경골평태손상환자개체화선택괄당적내고정진행치료,기중30례환자응용단측LCP고정;17례환자응용내、외쌍측강판고정;5례환자응용내、외、후측삼강판지탱고정. 술후정기복사X선편,의거골절유합적정황,지도환자행점진성공능단련. 채용미국특충외과의원( American hospital for special surgery,HSS)슬관절공능평분표준평정술후슬관절공능;채용Rasmussen슬관절방사학평분법평고술후영상학표현. 결과 본조환자술후획득수방6~22개월(평균12개월) ,무골절재이위급라정송동、내고정실효등병발증발생. 52례균획림상유합,유합시간위술후12~16주.4례환자우술후3d출현절구삼액현상,세균배양위음성,고필위지방액화소치,경환약치료후삼액소실. 1례환자발생만성골수염,후경환약、청창치유. HSS평분우량솔위86. 5%;술후Rasmussen방사학평분위13. 0~18. 0분,평균16. 3분. 결론 대우불동손상정도적루급쌍주혹삼주적복잡경골평태골절,술전응명학골절적손상정황,제정량호적수술방안,돌출개체화치료,채용단측、쌍측혹삼측LCP고정,가획득만의료효.
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 pa-tients with tibial plateau fractures underwent individualized internal fixation in our hospital according to the se-verity 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 pa-tients in progressive functional exercises, based on the status of fracture healing. The scoring standard of the A-merican 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 heal-ing 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.
