| 屠震宇.闭合复位经皮空心螺钉固定治疗闭合性胫骨平台骨折的临床观察研究德清中医院 骨伤科 屠震宇[J].浙江中西医结合杂志,2015,25(1): |
| 闭合复位经皮空心螺钉固定治疗闭合性胫骨平台骨折的临床观察研究德清中医院 骨伤科 屠震宇 |
| Management of closed tibial plateau fractures with percutaneous cancellous screw fixation: a preliminary report |
| 投稿时间：2014-04-28 修订日期：2014-07-16 |
| DOI： |
| 中文关键词: 闭合复位 胫骨平台骨折 |
| 英文关键词: |
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| 中文摘要: |
| 【】目的 探讨闭合复位经皮空心螺钉固定治疗闭合性胫骨平台骨折的早期临床疗效。方法 2009年1月至2012年12月间因闭合性胫骨平台骨折接受闭合复位经皮螺钉内固定治疗的患者24例,平均年龄为44.7±9.5岁,其中男23例,女7例。术中采用Esmarch绷带或点式复位钳经皮实施固定加压复位,经皮置入科氏针导针,之后经导针拧入适当长度的空心螺钉固定骨折。记录患者的手术时间,术中失血量以及透视时间等数据。随访中,采用Mason Hohl评估系统评价患者的功能及影像学效果。结果 术中平均透视时间为106s(78-135s),术中平均出血量为73.5mL (54-107mL) ,平均手术时间为54min(45-123min),所有病例手术切口均一期愈合,无感染病例发生。所有患者均获随访,平均随访时间为14个月。Mason Hohl功能及影像学评分分别由术前的3.8±1.2和2.9±0.9改善为术后末次随访时的10.8±1.4和11.2±1.1,术前与术后末次随访相比,差异均有统计学意义(P<0.05)。在末次随访时,经Mason Hohl评价,优18例,良好4例,可2例,总体优良率为91.7%。所有患者骨折均获得愈合,骨折的平均愈合时间为15.8w(12-19w)。无病例出现畸形愈合情况,亦无病例出现膝关节创伤性关节炎表现。随访期间无患者出现螺钉断裂,螺钉拔出内固定失败情况。结论 对于骨折移位或坍陷不重的胫骨平台骨折,闭合复位经皮螺钉固定技术是一种可供选择的手术治疗方式,该技术可实现固定微创、坚强固定,术后并发症并发生率低,有利于患者的早期关节功能训练和下床活动。 |
| 英文摘要: |
| 【】Objective To report on a novel technique of percutaneous cancellous screw fixation for tibial plateau fractures and to evaluate the clinical early results. Methods Between January 2009 and January 2012, with the closed reduction and percutaneous cancellous screw fixation was performed in 24 patients(17 men and seven women aged 44.7±9.5 years)with closed tibial plateau fractures. Reduction was done using Esmarch bandage or pointed clampSchecked under C-Arm. Reduction was held in place and then the guide wire was passed through which the screw was introduced. Fluoroscopy time, operation time and intraoperative blood loss were recorded. Grading of results was done as per Mason Hohl evaluation system depending on anatomical (radiological)Sand functional (clinical) assessment. Results The mean fluoroscopy time was 106s (range, 78-135s), the mean intraoperative blood loss was 73.5mL (54-107mL) and the mean operation time was 54min (range, 45-123min). All patients were followed up. The mean follow-up period was 14 months. All patients showed excellent knee function, with a mean Mason Hohl functional and radiological score of 10.8±1.4 and 11.2±1.1 at the latest follow-up. Compared with preoperative period(3.8±1.2 and 2.9±0.9), the difference was significant(P<0.05). Regarding complications, there was no occurrence of implant failure or infection. All fractures healed within a mean period of 15.8 weeks (range, 12–19 weeks) without loss of reduction. To the last follow-up, no cases for deformity healing, the traumatic knee arthritis, screw breakage and screw pull-out was found. Conclusions Percutaneous cancellous screw fixation for closed tibial plateau fractures is minimally invasive. It enables early mobilization with minimal instrumentation, and achieves satisfactory outcomes and low complications. |
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