注射性磷酸钙结合钢板治疗胫骨平台骨折(2)
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手术过程先复位骨折,然后注射磷酸钙填充骨缺损区,大约10min后,磷酸钙已达到足够的强度,这时行内固定术,骨折端不会移位。术中注意事项:①拉力螺钉不可拧得过紧,防止磷酸钙与骨折端再次断裂。②骨缺损区要填塞充分,以防止胫骨平台再塌陷。③骨缺损区填塞前尽量干燥,以便磷酸钙与自体骨结合。④注意检查膝关节的稳定性,必要时行韧带修补。⑤进行填塞时,为防止磷酸钙漏入关节腔应在填塞区周围放置无菌纱条。Thordarson[17]等进行的26例胫骨平台骨折应用可注射性磷酸钙,只有4例(2例在术后4-8周骨折移位,2例感染)需再手术干预,总的并发症发生率15.3%,其余病例骨折均愈合,术后平均负重时间为4.5周,膝关节功能恢复良好。本组试验中,27例患者伤口均一期愈合,无感染,排斥等不良反应发生,随访中未发现有胫骨平台塌陷情况。综上所述,可注射性磷酸钙结合内固定物是治疗胫骨平台骨折骨缺损的有效方法。
参考文献
[1]Marx RG,Jones EC,Allen AA,et al.Reliability,validity,and responsiveness of four knee outcome scales for athletic patients[J].Bone Joint Surg Am,2001,83-A(10):1459-1469.
[2]Ali AM,Saleh M,Bolongaro S,et al.Experimental model of tibial plateau fracture for biomechanical testing[J].Biomech,2006,9(7):1355-1360.
[3]汤旭日,王秋根,等.胫骨平台骨折术后高度丢失的原因及对策[J].中华创伤骨科杂志,2004,(3):260-263.
[4]Munting E,Mirtchi AA,Lematire .Bone repair of defects filled with a phosphocalcic hydraulic cement :an in vivo study[J].Mater Sci Mater Med,1993,4:337-44.
[5]Comuzzi L,Ooms E,Jansen JA.Injectable caicium phosphate cement as a filler for bone defects around oral implants:an experimental study in goats[J].Clin Oral Impl Res,2002,13:304-11.
[6]Kurashina K,Kurita H,Kotani A,Kobayashi S,Hirano M.Experimental cranioplastyyand skeletal augmentation using an atricalcium phosphate/dicalium phosphate dibasic/tetracalcium phosphate monoxide cement in rabbits[J].Biomaterials ......
手术过程先复位骨折,然后注射磷酸钙填充骨缺损区,大约10min后,磷酸钙已达到足够的强度,这时行内固定术,骨折端不会移位。术中注意事项:①拉力螺钉不可拧得过紧,防止磷酸钙与骨折端再次断裂。②骨缺损区要填塞充分,以防止胫骨平台再塌陷。③骨缺损区填塞前尽量干燥,以便磷酸钙与自体骨结合。④注意检查膝关节的稳定性,必要时行韧带修补。⑤进行填塞时,为防止磷酸钙漏入关节腔应在填塞区周围放置无菌纱条。Thordarson[17]等进行的26例胫骨平台骨折应用可注射性磷酸钙,只有4例(2例在术后4-8周骨折移位,2例感染)需再手术干预,总的并发症发生率15.3%,其余病例骨折均愈合,术后平均负重时间为4.5周,膝关节功能恢复良好。本组试验中,27例患者伤口均一期愈合,无感染,排斥等不良反应发生,随访中未发现有胫骨平台塌陷情况。综上所述,可注射性磷酸钙结合内固定物是治疗胫骨平台骨折骨缺损的有效方法。
参考文献
[1]Marx RG,Jones EC,Allen AA,et al.Reliability,validity,and responsiveness of four knee outcome scales for athletic patients[J].Bone Joint Surg Am,2001,83-A(10):1459-1469.
[2]Ali AM,Saleh M,Bolongaro S,et al.Experimental model of tibial plateau fracture for biomechanical testing[J].Biomech,2006,9(7):1355-1360.
[3]汤旭日,王秋根,等.胫骨平台骨折术后高度丢失的原因及对策[J].中华创伤骨科杂志,2004,(3):260-263.
[4]Munting E,Mirtchi AA,Lematire .Bone repair of defects filled with a phosphocalcic hydraulic cement :an in vivo study[J].Mater Sci Mater Med,1993,4:337-44.
[5]Comuzzi L,Ooms E,Jansen JA.Injectable caicium phosphate cement as a filler for bone defects around oral implants:an experimental study in goats[J].Clin Oral Impl Res,2002,13:304-11.
[6]Kurashina K,Kurita H,Kotani A,Kobayashi S,Hirano M.Experimental cranioplastyyand skeletal augmentation using an atricalcium phosphate/dicalium phosphate dibasic/tetracalcium phosphate monoxide cement in rabbits[J].Biomaterials ......
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