基于骨皮质形态特点选择胫骨下段骨折钢板固定位置

摘要

Objective To explore the morphological characteristics of cortical bone in mid-distal tibial related to plate location in mid-distal tibial fracture.Methods 46 patients with lower segmental tihial fractures ( no pilon fractures )were hospitalized.and divided into two groups ( 23 patients fixed with medial plate, 23 patients fixed with lateral plate ).The occurrence of postoperative complications were recorded and compared separately hetween the two groups.All patients were followed clinically and radiographically.CT reconstruction was used to evaluate the affected tibial bone cortex.calculated using Photoshop 7.0 software calculated cortical area.Results Patients were followed up for 12 ～ 36 months after the operative treatment.By comparison with the medial plate group, the lateral plate group had a higher rate of delayed union ( P ＜ 0.05 ).By mid-distal tibial bone cortical area comparison, the medial bone cortical area was bigger than the lateral bone cortical area( P ＜ 0.01 ) , anterior bone cortical area was bigger than the posterior bone cortical area( P ＜ 0.01 ).Conclusions This may raise concerns about the widespread use of the medial plate fixation in distal tibial fractures ( no pilon fractures ) because it is better suited to cortical bone biomechanical characteristic and less complications.%目的 探讨骨皮质形态特点对胫骨中下段骨折钢板内固定位置的作用.方法 手术治疗46例不涉及关节面的胫骨下段骨折,其中胫骨内侧解剖型钢板内固定23例(内侧固定组),胫骨外侧解剖型钢板内固定23例(外侧固定组).比较两种术式的并发症发生情况.进行临床和X线片检查随访,同时CT重建患侧胫骨骨皮质,利用Photoshop 7.0软件计算骨皮质面积.结果 患者均获随访,时间12~36个月.内侧固定组出现骨折迟缓愈合1例,无骨折移位;外侧固定组出现骨折迟缓愈合6例,骨折移位2例.与外侧固定组比较,内侧固定组骨折迟缓愈合率低(P<0.05).胫骨中远段骨皮质面积比较,内侧骨皮质面积较外侧骨皮质大(P<0.01),前侧骨皮质面积较后侧骨皮质大(P<0.01).结论 对于闭合不涉及关节面的胫骨下段骨折,内侧固定组具有更加符合天然骨生物力学条件、并发症少等特点,应优先考虑使用.