目的 探讨锁定加压钢板(LCP)、有限内固定+外固定支架及解剖钢板固定方法在胫骨下段粉碎性骨折治疗中的效果.方法 对211例胫骨下段粉碎性骨折患者进行手术治疗,分别采用LCP、有限内固定+外固定支架及解剖钢板进行固定,比较其临床疗效.结果 三种固定方法术后延迟愈合及骨不连发生率:有限内固定+外固定支架组为8.7%,解剖钢板组为17.8%,LCP组为5.8%;踝关节恢复情况:解剖钢板组有9例,有限内固定+外固定支架组3例踝关节功能恢复不良,影响正常生活,LCP组踝关节全部恢复正常;并发症发生率:有限内固定+外固定支架组为15.2%,解剖钢板组为12.6%,LCP组4.65%.结论 通过愈合效果、并发症发生以及踝关节恢复等几个方面的比较可以看出,LCP及有限内固定+外固定架组疗效较为满意,而LCP固定牢固,无需剥离骨膜,手术可采用微创皮下放置,破坏血供少,发生骨不连几率小,体现了生物学固定的优点,是治疗胫骨下段粉碎性骨折的有效方法.%Objective To study the effect of three ways of fixations in the treatment of distal tibia] comminuted fractures. Methods Totally 211 patients with distal tibial eomminuted fractures were enrolled in this study.Three methods including locking compression plate(LCP) ,internal/external fixation and anatomical plate were used in the treatment. Results The delayed healing and nonunion rate was 5.8% in LCP group,17.8% in anatomical plate group and 8.7% in internal/external fixation group. The article recovery rate was 100% in the LCP group and unsatisfied ankle recovery was observed in 9 patients in anatomical plate group and 3 patients in internal/external fixation group. The postoperative complication rate was 15.2% in internal/external fixation group, 12.6% in anatomical plate group and 4.65% in LCP group. Conclusion By comparing the delayed healing,nonunion rate,ankle recovery andthe complications rate,the effect of LCP and internal/external fixation is satisfactory. The LCP fixation has advantages of stable fixation,no need to strip the periosteum, mitllmal invasiveness ,less damage to the blood supply, low incidence of bone nonunion,which is an effective method for the treatment of distal tibia] comminuted fractures.
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