有限切开复位结合前外侧 L 形锁定加压接骨板内固定治疗胫骨远端干骺端骨折

摘要

目的：探讨胫骨远端干骺端骨折应用有限切开复位结合前外侧L形锁定加压接骨板（ locking compression plate， LCP）内固定治疗的临床疗效。方法2011年6月～2013年1月共收治15例胫骨远端干骺端骨折患者。骨折按照国际内固定研究协会（ AO／ASIF）分型：43A2型3例，43A3型10例，43B1型2例，均合并腓骨下端骨折；胫骨远端干骺端骨折线距踝关节面1.6～4.5cm，平均2.8cm；闭合性骨折8例，开放性骨折7例（ GustiloⅠ型2例，Ⅱ型3例，ⅢA型2例）。 GustiloⅢA型2例急诊行清创、腓骨内固定及外固定支架固定，余患者术前行跟骨骨牵引。运用有限切开复位结合前外侧L形LCP内固定治疗，术中酌情植骨，术后早期功能锻炼。结果所有患者术后获12～18个月（平均16个月）随访，术后2例切口表皮坏死，经换药处理后愈合，余切口均一期愈合。骨折于术后16～24周（平均20周）获骨性愈合。末次随访时根据美国骨科协会足踝外科分会（ American Orthopedic Foot Ankle Society，AOFAS）评分标准：评分为73～95分，平均89.5分，其中优10例，良3例，可2例，优良率86.7％。随访期间无感染、骨不连及内固定松动断裂等并发症发生。结论采用有限切开复位结合前外侧L形LCP内固定治疗胫骨远端干骺端骨折，术中利用微创置板技术，并酌情植骨，术后早期功能锻炼，可获得良好疗效。%Objective To investigate the clinical effects of limited open reduction and internal fixation with anterolateral L-shape locking compression plate for treatment of distal metaphyseal tibial fractures.Methods Fifteen patients with distal metaphyseal tibial fractures were treated in our department between Jun.2011 and Jan.2013.According to AO/ASIF classification,3 patients were with Type 43A2 fracture,10 patients with Type 43A3 fracture, 2 patients with Type 43B1 fracture and all were combined with lower fibula fractures.The distance from the fracture line of distal metaphyseal tibia to the ankle joint surface was 1.6-4.5cm (average 2.8cm).There were 8 cases of closed fractures and 7 cases of open fractures( Gustilo-Anderson Type I fracture in 2 cases,Type II in 3 cases,Type IIIA in 2 cases) .Two cases of Gustilo Type IIIA were treated by emergency debridement,internal fixation of fibula and external fixation,and others with calcaneal traction.Limited open reduction and internal fixation with anterolat-eral L-shape locking compression plate were performed,bone graft was performed in necessity and early exercise was encouraged after operation.Results All patients were followed up for 12-18 months(average 16 months).Two cases developing epidermal necrosis after operation were healed by dressing;others were healed in the first stage. The fractures healed 20 (16-24 weeks) weeks after surgery.According to American Orthopaedic Foot and Ankle Society(AOFAS) score at the last follow-up,the mean score was 89.5(ranging from 73-95) points,and excellent re-sults were found in 10 patients,good in 3 and fair in 2.The excellent and good rate was 86.7%.No infection,bone nonunion and breakage of internal fixation complications occurred during the follow-up.Conclusion Limited open reduction and internal fixation with anterolateral L-shape locking compression plate for the treatment of distal me-taphyseal tibial fractures make use of minimally invasive plate technology with bone graft in necessity and early exer-cise after operation.It can obtain a good effect.