双切口双钢板及锁定钢板内固定修复胫骨平台骨折的稳定性比较.doc

双切口双钢板及锁定钢板内固定修复胫骨平台骨折的稳定性比较李世芳，孙 健，周道政重庆市开县人民医院骨科一病区，重庆市 405400Stability of dual-incision double-plate fixation versus locking plate fixation for tibial plateau fractureLi Shi-fang, Sun Jian, Zhou Dao-zhengFirst Ward, Department of Orthopedic Surgery, Peoples Hospital of Kai County, Chongqing 405400, China摘要 背景：Schazker 、型骨折常造成交叉韧带、侧副韧带及半月板等部位的损伤，且塌陷移位严重，若仅采用一侧锁定钢板，则较难支撑及满意复位。目的：比较双切口双钢板内固定与膝前正中切口锁定钢板内固定修复Schatzker 、型胫骨平台骨折后的效果及稳定性评价。方法：纳入76例Schazker 、型胫骨平台骨折患者，分别采用锁定钢板内固定(n=38)和双切口双钢板内固定(n=38)进行治疗，通过X射线正、侧位片评估骨折复位及愈合情况，并对胫骨平台内翻角、胫骨平台内侧后倾角进行生物力学测试。结果与结论：双切口双钢板内固定组住院时间、内固定后开始负重时间显著少于锁定钢板内固定组(P 0.05)；关节强直、骨折延迟愈合、针道感染、骨折延迟愈合、膝内翻畸形多项并发症比较，双切口双钢板内固定组显著少于锁定钢板内固定组，差异均有显著性意义(P 0.05)；双切口双钢板内固定组内固定后Rasmussen分级明显优于锁定钢板内固定组，差异均有显著性意义(P 0.05)。结果说明治疗Schatzker 、型胫骨平台骨折，双切口双钢板内固定的临床疗效优于膝前正中切口锁定钢板内固定，更具有生物力学上的稳定性。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程全文链接：窗体顶端关键词 ： 植入物； 骨植入物； 胫骨平台骨折； 植骨； 锁定钢板内固定； 双切口双钢板内固定； 生物力学； Abstract： BACKGROUND: Schatzker V, VI fracture often causes the injuries to cruciate ligament, collateral ligaments and meniscus. Moreover, the collapse and shifting were severe. The locking plate on one side cannot support the weight or obtain satisfactory reduction. OBJECTIVE: To compare the effects and stability of the dual-incision double-plate fixation and knee midline incision locking plate fixation in the treatment of Schatzker V, VI tibial plateau fracture. METHODS: A total of 76 patients with Schatzker V, VI tibial plateau fracture were respectively treated with locking plate fixation (n=38) and dual-incision double-plate fixation (n=38). Fracture reduction and healing were assessed using anteroposterior and lateral radiographs. Varus angle and medial caster angle of tibial plateau received biomechanical measurement. RESULTS AND CONCLUSION: Hospital stay and postoperative load time were significantly less in the dual-incision double-plate fixation group than in the locking plate fixation group (P 0.05). The number of complications, such as ankylosis, fracture delayed union, pin tract infection, delayed union, varus deformity, was significantly fewer in the dual-incision double-plate fixation group than in the locking plate fixation group (P 0.05). Postoperative Rasmussen classification was significantly better in the dual-incision double-plate fixation group than in the locking plate fixation group (P 0.05). Experimental results indicated that the clinical efficacy of the dual-incision double-plate fixation is superior to that of the anterior cruciate midline incision locking plate fixation in the treatment of Schatzker V, VI type tibial plateau fractures. The dual-incision double-plate fixation has more biomechanical stability.中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程全文链接：Key words： tibia; tibial fractures; bone transplantation; ankylosis; internal fixators; biomechanics; 窗体底端 中图分类号:R318 通讯作者: 周道政，主任医师，重庆市开县人民医院骨科一病区，重庆市 405400 作者简介: 李世芳，男，1974年生，甘肃省民乐县人，汉族，2011年南华大学医学院毕业，硕士，副主任医师，主要从事脊柱及关节外科的临床研究。引用本文: 李世芳,孙 健,周道政. 双切口双钢板及锁定钢板内固定修复胫骨平台骨折的稳定性比较J. 中国组织工程研究, 2014, 18(26): 41796-4184. Li Shi-fang,Sun Jian,Zhou Dao-zheng. Stability of dual-i