單純內(nèi)固定與結(jié)合外固定支架治療復(fù)雜脛骨平臺(tái)骨折的比較

1、單純內(nèi)固定與結(jié)合外固定支架治療復(fù)雜脛骨平臺(tái)骨折的比較The comparison of fixation with external fixation with external fixation for fracture of complex tibial platformSource: /Ni lings dragon, huangdonghui tian kun mei peak【 abstract 】 objective to study the simple application of proximal tibial locking plate with proximal tibi

2、al locking plate combined with external fixator curative effect evaluation for the treatment of tibial plateau fractures. Methods: in July 2009, in July 2010, a total of 12 cases of tibial fractures were treated with proximal tibia, 9 men and 3 women; Age 22 63, average 42.5 years; According to the

3、schatzker type 1: type 5, type 8, type 4; The anterior medial incision and the anterior lateral incision were used in the technique, which was placed in the medial and lateral area of the tibia. There were 8 cases of fracture of the tibia platform with external fixation with the tibia proximal fixat

4、ion, 4 cases, 4 women; Age 27-56, average 41.5 years; According to the schatzker: type v 6, type 2; In the technique, the stent was placed in the distal end of the femur and the proximal tibia in the proximal tibia, and the inside of the tibia on the medial side of the tibia and the outside of the t

5、ibia were placed in the fixation plate. Results pure application of the proximal tibia 12 patients, 11 patients with locking plate for follow-up, all patients without fracture nonunion or delayed union, no bone fascia room syndrome and deep venous thrombosis of lower limbs. The function of the knee

6、joint was rated 72-90 by the HSS scoring method, averaging 81.0. Patients with external fixator combined with proximal tibial locking plate 8 patients all received follow-up, all patients without fracture nonunion or delayed union, no bone fascia room syndrome and deep venous thrombosis of lower lim

7、bs. The HSS scoring method was rated 76-90, averaging 83.0. Conclusion the external fixator combined with proximal tibial locking plate treatment for complex fractures of tibial plateau with simple application of proximal tibial locking plate, provides a more stable fixation, prevent the secondary c

8、ollapse, fracture, reduce the surgical complications, knee joint functional recovery satisfaction.【 keywords 】 a fracture of the tibia platform; Internal fixation; The knee jointTibial plateau fractures is a relatively common intra-articular fractures, the treatment for complex fractures of tibial p

9、lateau (mainly by schazker parting fracture of 5, 6) method is also varied, commonly used methods for widely exposed double plate fixation. Because of the specific anatomical characteristics of the tibia platform, the difficulty of reposition in the fixation of the resection was performed, and there

10、 were more complications, affecting the function of the joints. The author in July 2006 - July, 2008, using Wu Hankang ted technology co., LTD. Production of external fixator combined with shandong weigao company proximal tibial locking plate group complex tibial plateau fractures treated 8 cases, a

11、nd treatment of complex tibial plateau fractures with the traditional method group of 12 cases were compared, follow-up clinical curative effect satisfaction, now report as follows.1 clinical data1.1 simple internal fixed group1.1.1 general data sets 12 cases, 9 men, 3 women: ages 22 63, average 42.

12、5 years. Causes of injury: 8 cases of car accident, 4 cases of heavy weight and 4 cases of closed fracture. All cases were fresh fractures. The group is based on the schatzker: the v type 7, the type 5; Three cases of emergency surgery were performed between 7 to 14 days after the injury and 8 cases

13、 were treated with bone traction. The cases in this group were used to lock steel plates in the tibia of shandong weigao company.Prior to the operation, the examination was completed before the operation of the surgery, especially in the case of the soft tissue of the knee, the degree of local swell

14、ing and the condition of the arterial pulsation after the tibia. If the soft tissue lesion is serious, the line of force of the dry epiphyseal fracture is restored, and the reoperation after the swelling is gone. Preoperative knee is, lateral x ray film, understand the fracture cases, ct scanning an

15、d 3 d reconstruction when necessary to further understand the fracture morphology and fracture position, preoperative prophylactic use of antibiotics.1.1.3 meets surgical methods intravenous anesthesia or continuous epidural anesthesia, general upper thigh tourniquet, the fracture of the medial spli

16、t, subsidence mainly choose medial incision into before; The lateral cleft, the collapse of the fracture and the selection of the anterior lateral incision; The double condyle fracture can be used in the lateral incision of the lateral area, and the medial incision is required when necessary. The me

17、dian incision, the z cut off the iliac tendon or the opening of the iliac tentibial tubercle, fully exposed the dycondyle fracture. Through methods such as traction or dial the reset, the lower cavity bone graft (autologous bone or artificial bone are available, and can also use a combination of the

18、se), with one of the needle was 1.5 mm in diameter about 0.5 cm below the joint surface of flat surface joints through the temporary fixed, in 1 2 pieces of cancellous bone screw joint surface in parallel, the inside and outside fixed platform as a whole, to restore the tibia platform width, c arm m

19、achine after radiography fracture counterpoint satisfaction to the line, steel plate and screw internal fixation. When the fracture is restored, make as much as possible the remaining meniscus. During the procedure, the lesion of ligament damage is done. At the end of the operation, the normal negat

20、ive pressure drainage is placed. Two weeks after operation, quadriceps and CPM functions were performed.The weight of the limb was three months later.1.2 simple internal fixation with external fixed support group1.2.1 general data group 8 cases, 4 men, 4 women: age 27 to 56 years old, average 41.5 y

21、ears, according to schatzker: 5, 6, 6, 2; Causes of injury: four cases of car accident, 2 cases of heavy weight and 2 cases of falling injury, all of which are closed fractures. All cases were fresh fractures. The group was based on the schatzker: type v 6, type 2, 2; Three cases of emergency surger

22、y were performed between 7 to 14 days after the injury and 4 routine and bone traction treatment. The cases in this group were used in the combination of the outer fixed brackets made by wuhan constad technology co., LTD. And the tibia proximal plate of shandong weigao company.1.2.2 preoperative per

23、fecting correlative preoperative knee is, lateral x ray film, understand the fracture, ct scanning and 3 d reconstruction when necessary to further understand the fracture morphology and fracture position, mri know, soft tissue injury of preoperative prophylactic use of antibiotics. If the soft tiss

24、ue lesion is serious, the line of force of the dry epiphyseal fracture is restored, and the reoperation after the swelling is gone. As shown in figure 1. Figure 11.2.3 meets surgical methods intravenous anesthesia or continuous epidural anesthesia, general upper thigh tourniquet, front ahead of prox

25、imal femur and tibia midway through the screw in two external fixator steel needle, then respectively for inside the knee, the lateral incision, fully exposed fracture end, installation of external fixation support, open fractures insert, supplemented by become warped reset, which for the artificial

26、 bone graft. Electricity through the reset satisfaction, use a long cancellous screw from fixed in tibia platform fracture piece inside extroversion, the inside and outside pressure fixed platform, platform width. After the position of the fracture of the frame of the arm machine is satisfactory to

27、the line, the outside support plate is fixed. To remove the fracture of the cruciate ligament and use a wire, repair the meniscus tear, and put the negative pressure. As shown in figure 2, figure 3. Figure 2 to figure 3 push up limb, postoperative activities ankle, hip to prevent blood clots, pinhol

28、e nursing, postoperative 4 weeks bed crutch, 6 weeks removed external fixation support, began to passive knee joint functional exercise. Start at 12 weeks with full load. 2 the resultsThe 12 patients with 12 patients were followed for 4 to 16 months, with an average of 10.0 months. All patients had

29、no bone fractures or delayed healing, no bone fascia, and deep vein embolism. The average fracture healed 3.3 months. Preoperative and postoperative and 6 months after X-ray inspection comparison in phase ii of tibial plateau collapse 3 cases, more than 8 cases, there was no second stage collapse an

30、d adverse to the line, knee flexion 90 120 . The function of the knee joint was rated 72-90 by the HSS scoring method, averaging 81.0. The patients were followed up for 6 to 16 months with an average of 11.0 months. All patients had no bone fractures or delayed healing, no bone fascia, and deep vein

31、 embolism. The average fracture of the fracture is 3.1 months. Preoperative and postoperative and 6 months after X-ray inspection comparison not phase ii of tibial plateau collapse and lost, bad value line, knee flexion 95 125 . The HSS scoring method was rated 76-90, averaging 83.0. Conclusion: the

32、 external fixator combined with proximal tibial locking plate treatment of complex tibial plateau fractures with simple application of proximal tibial locking plate, provides a more stable fixation, prevent the secondary collapse, fracture, reduce the surgical complications, knee joint functional re

33、covery satisfaction.3 discuss3.1 tibial platform aims to reshape the articular surface of tibial plateau fracture surgery, reconstruction of knee joint match relationship, correct the lines of force of lower limb, recovery of knee joint stability and activity. The postoperative complication of the t

34、ibia platform is the stiffness of the knee joint, the internal and external collapse of the knee, the secondary collapse, the unstable knee, and the late stage of traumatic arthritis. Causes of postoperative complications of tibia platform fracture: (1) fracture reduction is not ideal; (2) the choic

35、e of the fixed object is inappropriate; (3) inadequate graft; (4) improper handling of ligaments and meniscus; (5) postoperative function is not reasonable. In protecting the fracture under the condition of blood supply, as far as possible to reset the anatomy of tibial plateau and bone graft in ful

36、l, such as right screw plate relatively strong fixation, early of load under the knee joint function training is the key to achieve good operation effect. 2. According to the ao theory, internal fixation is not a permanent replacement bone, but instead provides temporary support to the right positio

37、n of the limb and early functional exercise and healing. Liss grafting is based on the internal stents, which have no reset function, and the good reposition is the base 3 of the steel plate. The author found that adopting external fixator for traction reduction, is conducive to place steel plate, s

38、horten the operation time, obvious effect, reduce the soft tissue separation due to reset. And there is better anti-shear stress, which can prevent or reduce the shear shift after fracture surgery,The fracture was not found after the fracture.3.2 pure internal fixation combined with external fixatio

39、n and advantages of stents with literature reports, using traditional midline incision of the double plate fixation method had a higher rate of postoperative skin necrosis and infection rates, this is due to the double steel plate internal fixation need the inside of the broader exposure, skin flap

40、of the wide strip, easy cause soft tissue complications. Luo is reported to have been using improved double-plate technology for the treatment of complicated tibia platform fractures. The key is to provide stable and fixed, while reducing the damage to surrounding soft tissue. It is an effective met

41、hod of using external fixation to assist indirect reposition. In the preoperative calcaneal traction, reduce swelling, to ensure that the fracture of registration on line at the same time, can reduce the continued oppression of skin soft tissue, protect the soft tissues around the knee joint, maximu

42、m operation after limb swelling subsided, an average of 11.5 days, is advantageous to the soft tissue repair, therefore, all 20 patients were no complications such as incision infection and skin necrosis occurred.Postoperative management followed the principle of early activity, later weight. Joint

43、rigidity is a major complication of fracture of tibial plateau, the main reason is that after knee joint injury bleeding, bleeding, and knee braking for a long time, damage before sliding structure, quadriceps and shares before sliding structure adhesion, muscle atrophy, fibrosis. After four weeks a

44、fter operation, the patient was removed from the stent, the knee joint functional exercise, after the operation of the examination x line confirmed the fracture clinical healing before the weight lifting activity.3.4 external fixation support problems that should pay attention to the clinical applic

45、ation of external fixator deficiency, mainly postoperative infection may appear the needle, fracture healing and osteomyelitis. So on postoperative nursing care of external fixation support becomes more important, the authors experience is to observe whether loose needles, secretion, clear if there is need to timely treatment, pin should be open around, with 75% alcohol drop needle, 2 times a day. Complexity for the treatment of tibial plateau fracture has a lot of, due to the complexity of the injury, the treatm