应用锁定加压接骨板外固定方法治疗胫腓骨骨折
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摘要
目的:探讨锁定加压接骨板(LCP)外固定治疗胫骨骨折中的应用要点、适应症和并发症的预防。
方法:自2006年10月至2008年8月应用锁定加压接骨板(LCP)外固定方法治疗胫腓骨骨折38例。其中男26例,女12例;年龄12～74岁,平均年龄45岁;胫骨平台骨折10例,胫骨干骨折19例,胫骨下端(Pilon)骨折9例;闭合性骨折29例,开放性骨折9例。手术采用透视下复位LCP外固定方法固定骨折。术后每月随访1次。
结果:术后随访8～18个月,平均10个月。38例患者均达到功能复位,并获得骨性愈合。除一例开放性骨折患者出现皮肤坏死伤口延迟愈合外,其余患者均一期愈合。骨折平均愈合时间为8个月。按Johner-Wruhs功能评价法,优23例,良13例,可2例,优良率94.7%。
结论:应用LCP外固定方法治疗胫腓骨骨折,手术操作简便,并发症少,可早期功能锻炼,是良好的治疗胫腓骨骨折的微创手术方法。
Objective: To approach clinical therapeutic effect、indication、prevention of complication of tibiofibula fractures which were treated by external fixation with the locking compression plate system.
Methods: To treat thirty-eight tibiofibula fracture patients from October 2006 to Augest 2008 by external fixation with the locking compression plate system. There are 26 male patients and 12 female patients.They aged from 12 to 74,and their average age is 45.There are 10 tibial plateau fracture patients, for tibial shaft fracture the number is 19,and for Pilon fracture the number is 9.Closed fracture is 29,and compound fracture is 9.We treated these tibiofibula fracture patients by under perspective reduction and external fiaxtion using the locking compression plate system.All the patients were rechecked once a month after the operation.
Results: All the patients were observed for 8～18 months, 10 months by average.All the fractures got functional reduction and became bone union.All the cases got primary healing,except a compound fracture case which got skin necrosis and delayed healing.The average time of the bone union is 8 months.We evaluated the cases by the Johner-Wruhs's fanctional effective standard of tibiofibula fracture:The number of excellent cases is 23,and the number of good cases is 13, common case is 2, fine rate is 94.7%.
Conclusion: External fiaxtion with the locking compression plate system, which got lower ratio of complication and allowed patients to do fanctional exercises immediately,is a convient operation treating the tibiofibula fractures.lt is a great microoperation method to deal with tibiofibula fractures.
方法:自2006年10月至2008年8月应用锁定加压接骨板(LCP)外固定方法治疗胫腓骨骨折38例。其中男26例,女12例;年龄12～74岁,平均年龄45岁;胫骨平台骨折10例,胫骨干骨折19例,胫骨下端(Pilon)骨折9例;闭合性骨折29例,开放性骨折9例。手术采用透视下复位LCP外固定方法固定骨折。术后每月随访1次。
结果:术后随访8～18个月,平均10个月。38例患者均达到功能复位,并获得骨性愈合。除一例开放性骨折患者出现皮肤坏死伤口延迟愈合外,其余患者均一期愈合。骨折平均愈合时间为8个月。按Johner-Wruhs功能评价法,优23例,良13例,可2例,优良率94.7%。
结论:应用LCP外固定方法治疗胫腓骨骨折,手术操作简便,并发症少,可早期功能锻炼,是良好的治疗胫腓骨骨折的微创手术方法。
Objective: To approach clinical therapeutic effect、indication、prevention of complication of tibiofibula fractures which were treated by external fixation with the locking compression plate system.
Methods: To treat thirty-eight tibiofibula fracture patients from October 2006 to Augest 2008 by external fixation with the locking compression plate system. There are 26 male patients and 12 female patients.They aged from 12 to 74,and their average age is 45.There are 10 tibial plateau fracture patients, for tibial shaft fracture the number is 19,and for Pilon fracture the number is 9.Closed fracture is 29,and compound fracture is 9.We treated these tibiofibula fracture patients by under perspective reduction and external fiaxtion using the locking compression plate system.All the patients were rechecked once a month after the operation.
Results: All the patients were observed for 8～18 months, 10 months by average.All the fractures got functional reduction and became bone union.All the cases got primary healing,except a compound fracture case which got skin necrosis and delayed healing.The average time of the bone union is 8 months.We evaluated the cases by the Johner-Wruhs's fanctional effective standard of tibiofibula fracture:The number of excellent cases is 23,and the number of good cases is 13, common case is 2, fine rate is 94.7%.
Conclusion: External fiaxtion with the locking compression plate system, which got lower ratio of complication and allowed patients to do fanctional exercises immediately,is a convient operation treating the tibiofibula fractures.lt is a great microoperation method to deal with tibiofibula fractures.
引文
[1]吴克俭,侯树勋,等.骨科实用固定技术[M].第一版.北京:人民卫生出版社,2007:1337.
[2]王秋根,张秋林,等.现代外固定支架治疗学[M].第一版.北京:人民军医出版社,2006.
[3]何从科.MIPPO技术LCP内固定术治疗老年胫骨骨折16例体会[J].右江医学,2008,36(3):318-319.
[4]Behrens,F,Searls,K.External fixation of the tibia.Basic concepts and prospective evaluation[J].J Bone Joint Surg,1986,68B:246.
[5]裴国献,郭刚,等.现代微创骨科学[M].第一版.北京:人民军医出版社,2008:571.
[6]蒋协远,王大伟,等.骨折临床疗效评价标准[M].第一版.北京:人民卫生出版社,2005:265-274.
[7]陈孝平,等.外科学(八年制)[M].第一版.北京:人民卫生出版社,2005:927-935.
[8]Frigg R,Locking compression plate(LCP).An osteosynthesisplate based on the dynamic compression plate and the.point contact fixator(PC-Fix)[J].Injury,2001,32(suppl 2):63-66.
[9]Ruedi TP,Sommer C.From the classical AO compression plate to the new internal fixator principle[J].Zhonghua chuangshang guke zhazhi: (Chins J orthop trauma),2003:212-217.
[10]胡茂忠,等.经皮LCP固定治疗胫腓骨骨折[J].中国矫形外科杂志,2008,16(2):135-137.
[11]Wenzl ME,Porte T,Fuchs S,et al.Delayed and non-union of the humeral diaphysis-compression plate fixator?[J].Injury,2004,35:55-60.
[12]Lill H,Hepp P,Rose T,et al.The angle stable locking proximal-humerus-plate (LPHP) for proximal humeral fractures using a small anterior-lateral-deltoid-Splitting approach-technique and first results [J].Zentralbl Chir,2004,129:43-48.
[13]Kreaek C,Schandelmaier P,Miclau T,et al.Minimally invasive prcuraneous plate asteosynthsis(MIPPO) using the DCS in proximal and distal femoral fraeture[J].Injury,1997,28(Suppl 1):20-30.
[14]Stoffel K,Dieter U,Stachowiak G,et al.How can stability in locked internal fixators be controlled?[J].Injury,2003,34(suppl 2):11.
[15]Wagner M.General principles for the clinical use of the LCP [J].Injury,2003,34(suppl 2):31.
[16]Steinemann SG.(1985)Corrosion of titanium and titanium alloys for surgical implant.In:Luejering G,Zwicker V,Bunk W,editors.Titanium,Science and Technology,1373-1379.
[17]Sics TD.External fixationP:historic review,advantages,disadvantages, complications,and indications[J].Clin Othop.1983.180:15.
[18]李起鸿.骨外固定原理与临床应用[M].成都:四川科技出版社,1992:17-39.
[19]Tscherne H,Trentz O.Technique of internal fixation and results in comminuted and multifragment fractures of the femoral shaft (collective study by the German Section of AO Internationl)(author' s transl)[J].Unfal lheilkunde,1977,80(5):221-230.
[20]Marti A,Fankhauser C,Frenk A,et al.Biomechanical evaluation of the less invasive stabilization system for the internal fixation of distal femur fractures[J].J Orthop Trauma,2001,15:482.
[21]马骏,等.LCP结合MIPPO技术治疗胫骨中下段骨折[J].中国当代医学,2008,7(2):55-56.
[22]Ungersboeck A,Geret V,Pohler O.Tissue reaction to bone plates made of pure titanium:a prospective,quantitative clinical study[J].Journal of Materials Science;Materials in Medicine,1995,6:223-229,
[23]Lill H,Hepp P,Korner J,et al.Proximal humeral fractures:how stiff should an implant be?Acomparative mechanical study with new implants in human specimen[J].Arch Orthop Trauma Surg,2003,123:74.
[1]胥少汀,葛宝丰,徐印坎,等.实用骨科学[M].第三版.北京:人民卫生出版社,2006:779-792.
[2]荣国威,王承武,等.骨折[M].第一版.北京:人民卫生出版社,2004:74-185,1137-1162.
[3]M(u|¨)ller ME,All(o|¨)gwer M,Schneider R,er al.Manual of Internal Fixation.3rd ed.Berlin Heidelberg New York:Springer-Verlag,1991.
[4]Gustilo RBAnderson JT.Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones:retrospective and prospective analyses[J].J Bone Joint Surg[Am],1976,58(4):453-458.
[5]郑南生,黎早敏,林坚平,等.外固定支架生物学固定在胫腓骨骨折中的应用[J].中华创伤骨科杂志,2004,6:474.
[6]Green S.Complications of external fixation.In:Uhthoff HK,editor.Current Concepts of External Fixation of Fractures.Berlin Hei delberg New York:Springer-Verlag,1982.
[7]Perren S(1990)Basic aspects of internal fixation.In:M(u|¨)ller ME,All(o|¨)gwer M,Schneider R,editors.Manual of Internal Fixation.Berlin Heidelberg New York:Springer-Verlag,1-112.
[8]Klein MP,Rahn BA,Frigg R,et al.Reaming versus non-reaming in medullary nailing:interference with cortical circulation of the canine tibia[J].Arch Orthop Trauma Surg,1990,109(6):314-316.
[9]Wenda K,Ritter G,Degreif J,et al.[Pathogenesis of pulmonary complications following intramedullary nailing osteosynthese][J].Unfallch irurg,1988,91(9):432-435.
[10]Pape HC,Krettek C,Maschek H,et al.Fatal pulmonary embolization after reaming of the femoral medullary cavity in sclerosing osteomyelitis:a ca se report[J].J Orthop Trauma,1996,10(6):429-432.
[11]罗宗富,何春雷,黄希勤,等.交锁髓内钉治疗开放性胫腓骨骨折的并发症及其防治[J].中华创伤骨科杂志,2004,6:470.
[12]BurnT F(1979)Elastic external fixation of tibia fractures:a study of 1421 cases.In:Brooker A,Edwards C,editors.External Fixation:The Curre nt State of the Art.London:Williams & Wilkins,55-73.
[13]Schatzker J.M.E.M(u|¨)ller-on his 80th Birthday[J].AO Dialogue,1998,11(1):7-12.
[14]Perren SM,Buchanan J.Basic concepts relevant to the design and development of the point contact fixator(PC-Fix)[J].Injury,1995,26(Suppl 2):1-4.
[15]Mast J(1991)Preoperative planning and principles of reduction.In:M(u|¨)ller ME,All(o|¨)gwer M,Schneider R,et al.,editors.Manual of internal fixation.Berlin Heidelberg New York:Springer-Verlag, 159-178.
[16] Tepic S,Perren SM.The biomechanics of the PC-Fix internal fixator[J].Injury,1995,26(Suppl 2):5-10.
[17] Fernandez Dell'Oca AA,Tepic S,Frigg R,et al.(In press)Treating fore arm fractures using an internal fixator:a prospective study.Clinical Orthopaedics and Related Research(1998).
[18] Naas N,Hauke C,Sch tz M,et al.Treatment of diaphyseal fractures of the forearm using the Point Contact Fixator (PC-Fix):results of 387 fractures of a prospective multicentric study(PC-Fix II)[J].Injury,2001,32:S51.
[19] Sch tz M,Kaab MJ,Haas N.Stabilization of proximal tibial fractures with the LISS System;early clinical experience in Berlin[J].Injury,2003,34:30.
[20] Krettek C.Concepts of minimally invasive plate osteosynthesis[J]. Injury, 1997,28(Suppl 1):1-6.
[21] Krettek C,Schandelmaier P,Miclau T,et al.Minimally invasive percutaneous plate osteosynthesis(MIPPO)using the DCS in proximal and distal femoral fractures[J].Injury,1997,28(suppl 1):20-30.
[22] Sch tz M,Muller M,Krettek C,et al.Minimally invasive fracture stabilization of distal femoral fractures with LISS:a prospective multicenter study.Results of a clinical study with special emphasis on difficult cases[J].Injury,2001,32(suppl 3):48.
[23]Collinge C,Sanders RW,DePasquale T:Treatment of complex tibial periarticular fractures using percutaneous[J].Clin Orthop,2000,375:69.
[24]Wagner M.General principles for the clinical use of the LCP[J].Injury,2003,34(suppl 2):31.
[25]Sommer C,Gautier E,Muller M,et al.First clinical results of the Locking Compression Plate(LCP)[J].Injury,2003,34(suppl 2):43.
[26]Gautier E,Sommer C.Guidelines for the clinical application of the LCP[J].Inj ury,2003,34(suppl 2):63.
[27]Stoffel K,Dieter U,Stachowiak G,et al.How can stability in locked internal fixators be controlled?[J].Injury,2003,34(suppl 2):11.
[28]余伟宏,雷刚刚,吴庆能,等.经皮锁定桥接钢板技术与带锁髓内钉技术治疗复杂性胫腓骨骨折[J].实用临床医学,2008,9(3):53-56.
[29]曹社国,曹永东.Ⅱ期微创手术治疗复杂胫腓骨骨折[J].中国现代医生,2008,46(18):24-25,34.
[30][瑞士]T.P.鲁迪,[英]W.M.墨菲,主编.王满宜,杨庆铭,等,主译.骨折治疗的AO原则[M].第一版.北京:华夏出版社,2003:518-537.
[2]王秋根,张秋林,等.现代外固定支架治疗学[M].第一版.北京:人民军医出版社,2006.
[3]何从科.MIPPO技术LCP内固定术治疗老年胫骨骨折16例体会[J].右江医学,2008,36(3):318-319.
[4]Behrens,F,Searls,K.External fixation of the tibia.Basic concepts and prospective evaluation[J].J Bone Joint Surg,1986,68B:246.
[5]裴国献,郭刚,等.现代微创骨科学[M].第一版.北京:人民军医出版社,2008:571.
[6]蒋协远,王大伟,等.骨折临床疗效评价标准[M].第一版.北京:人民卫生出版社,2005:265-274.
[7]陈孝平,等.外科学(八年制)[M].第一版.北京:人民卫生出版社,2005:927-935.
[8]Frigg R,Locking compression plate(LCP).An osteosynthesisplate based on the dynamic compression plate and the.point contact fixator(PC-Fix)[J].Injury,2001,32(suppl 2):63-66.
[9]Ruedi TP,Sommer C.From the classical AO compression plate to the new internal fixator principle[J].Zhonghua chuangshang guke zhazhi: (Chins J orthop trauma),2003:212-217.
[10]胡茂忠,等.经皮LCP固定治疗胫腓骨骨折[J].中国矫形外科杂志,2008,16(2):135-137.
[11]Wenzl ME,Porte T,Fuchs S,et al.Delayed and non-union of the humeral diaphysis-compression plate fixator?[J].Injury,2004,35:55-60.
[12]Lill H,Hepp P,Rose T,et al.The angle stable locking proximal-humerus-plate (LPHP) for proximal humeral fractures using a small anterior-lateral-deltoid-Splitting approach-technique and first results [J].Zentralbl Chir,2004,129:43-48.
[13]Kreaek C,Schandelmaier P,Miclau T,et al.Minimally invasive prcuraneous plate asteosynthsis(MIPPO) using the DCS in proximal and distal femoral fraeture[J].Injury,1997,28(Suppl 1):20-30.
[14]Stoffel K,Dieter U,Stachowiak G,et al.How can stability in locked internal fixators be controlled?[J].Injury,2003,34(suppl 2):11.
[15]Wagner M.General principles for the clinical use of the LCP [J].Injury,2003,34(suppl 2):31.
[16]Steinemann SG.(1985)Corrosion of titanium and titanium alloys for surgical implant.In:Luejering G,Zwicker V,Bunk W,editors.Titanium,Science and Technology,1373-1379.
[17]Sics TD.External fixationP:historic review,advantages,disadvantages, complications,and indications[J].Clin Othop.1983.180:15.
[18]李起鸿.骨外固定原理与临床应用[M].成都:四川科技出版社,1992:17-39.
[19]Tscherne H,Trentz O.Technique of internal fixation and results in comminuted and multifragment fractures of the femoral shaft (collective study by the German Section of AO Internationl)(author' s transl)[J].Unfal lheilkunde,1977,80(5):221-230.
[20]Marti A,Fankhauser C,Frenk A,et al.Biomechanical evaluation of the less invasive stabilization system for the internal fixation of distal femur fractures[J].J Orthop Trauma,2001,15:482.
[21]马骏,等.LCP结合MIPPO技术治疗胫骨中下段骨折[J].中国当代医学,2008,7(2):55-56.
[22]Ungersboeck A,Geret V,Pohler O.Tissue reaction to bone plates made of pure titanium:a prospective,quantitative clinical study[J].Journal of Materials Science;Materials in Medicine,1995,6:223-229,
[23]Lill H,Hepp P,Korner J,et al.Proximal humeral fractures:how stiff should an implant be?Acomparative mechanical study with new implants in human specimen[J].Arch Orthop Trauma Surg,2003,123:74.
[1]胥少汀,葛宝丰,徐印坎,等.实用骨科学[M].第三版.北京:人民卫生出版社,2006:779-792.
[2]荣国威,王承武,等.骨折[M].第一版.北京:人民卫生出版社,2004:74-185,1137-1162.
[3]M(u|¨)ller ME,All(o|¨)gwer M,Schneider R,er al.Manual of Internal Fixation.3rd ed.Berlin Heidelberg New York:Springer-Verlag,1991.
[4]Gustilo RBAnderson JT.Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones:retrospective and prospective analyses[J].J Bone Joint Surg[Am],1976,58(4):453-458.
[5]郑南生,黎早敏,林坚平,等.外固定支架生物学固定在胫腓骨骨折中的应用[J].中华创伤骨科杂志,2004,6:474.
[6]Green S.Complications of external fixation.In:Uhthoff HK,editor.Current Concepts of External Fixation of Fractures.Berlin Hei delberg New York:Springer-Verlag,1982.
[7]Perren S(1990)Basic aspects of internal fixation.In:M(u|¨)ller ME,All(o|¨)gwer M,Schneider R,editors.Manual of Internal Fixation.Berlin Heidelberg New York:Springer-Verlag,1-112.
[8]Klein MP,Rahn BA,Frigg R,et al.Reaming versus non-reaming in medullary nailing:interference with cortical circulation of the canine tibia[J].Arch Orthop Trauma Surg,1990,109(6):314-316.
[9]Wenda K,Ritter G,Degreif J,et al.[Pathogenesis of pulmonary complications following intramedullary nailing osteosynthese][J].Unfallch irurg,1988,91(9):432-435.
[10]Pape HC,Krettek C,Maschek H,et al.Fatal pulmonary embolization after reaming of the femoral medullary cavity in sclerosing osteomyelitis:a ca se report[J].J Orthop Trauma,1996,10(6):429-432.
[11]罗宗富,何春雷,黄希勤,等.交锁髓内钉治疗开放性胫腓骨骨折的并发症及其防治[J].中华创伤骨科杂志,2004,6:470.
[12]BurnT F(1979)Elastic external fixation of tibia fractures:a study of 1421 cases.In:Brooker A,Edwards C,editors.External Fixation:The Curre nt State of the Art.London:Williams & Wilkins,55-73.
[13]Schatzker J.M.E.M(u|¨)ller-on his 80th Birthday[J].AO Dialogue,1998,11(1):7-12.
[14]Perren SM,Buchanan J.Basic concepts relevant to the design and development of the point contact fixator(PC-Fix)[J].Injury,1995,26(Suppl 2):1-4.
[15]Mast J(1991)Preoperative planning and principles of reduction.In:M(u|¨)ller ME,All(o|¨)gwer M,Schneider R,et al.,editors.Manual of internal fixation.Berlin Heidelberg New York:Springer-Verlag, 159-178.
[16] Tepic S,Perren SM.The biomechanics of the PC-Fix internal fixator[J].Injury,1995,26(Suppl 2):5-10.
[17] Fernandez Dell'Oca AA,Tepic S,Frigg R,et al.(In press)Treating fore arm fractures using an internal fixator:a prospective study.Clinical Orthopaedics and Related Research(1998).
[18] Naas N,Hauke C,Sch tz M,et al.Treatment of diaphyseal fractures of the forearm using the Point Contact Fixator (PC-Fix):results of 387 fractures of a prospective multicentric study(PC-Fix II)[J].Injury,2001,32:S51.
[19] Sch tz M,Kaab MJ,Haas N.Stabilization of proximal tibial fractures with the LISS System;early clinical experience in Berlin[J].Injury,2003,34:30.
[20] Krettek C.Concepts of minimally invasive plate osteosynthesis[J]. Injury, 1997,28(Suppl 1):1-6.
[21] Krettek C,Schandelmaier P,Miclau T,et al.Minimally invasive percutaneous plate osteosynthesis(MIPPO)using the DCS in proximal and distal femoral fractures[J].Injury,1997,28(suppl 1):20-30.
[22] Sch tz M,Muller M,Krettek C,et al.Minimally invasive fracture stabilization of distal femoral fractures with LISS:a prospective multicenter study.Results of a clinical study with special emphasis on difficult cases[J].Injury,2001,32(suppl 3):48.
[23]Collinge C,Sanders RW,DePasquale T:Treatment of complex tibial periarticular fractures using percutaneous[J].Clin Orthop,2000,375:69.
[24]Wagner M.General principles for the clinical use of the LCP[J].Injury,2003,34(suppl 2):31.
[25]Sommer C,Gautier E,Muller M,et al.First clinical results of the Locking Compression Plate(LCP)[J].Injury,2003,34(suppl 2):43.
[26]Gautier E,Sommer C.Guidelines for the clinical application of the LCP[J].Inj ury,2003,34(suppl 2):63.
[27]Stoffel K,Dieter U,Stachowiak G,et al.How can stability in locked internal fixators be controlled?[J].Injury,2003,34(suppl 2):11.
[28]余伟宏,雷刚刚,吴庆能,等.经皮锁定桥接钢板技术与带锁髓内钉技术治疗复杂性胫腓骨骨折[J].实用临床医学,2008,9(3):53-56.
[29]曹社国,曹永东.Ⅱ期微创手术治疗复杂胫腓骨骨折[J].中国现代医生,2008,46(18):24-25,34.
[30][瑞士]T.P.鲁迪,[英]W.M.墨菲,主编.王满宜,杨庆铭,等,主译.骨折治疗的AO原则[M].第一版.北京:华夏出版社,2003:518-537.