中华临床医师杂志(电子版) 2017年2月,11卷4期

综 述

胫骨远端关节外骨折的治疗研究进展

杜武军1,2 徐彬2 刘宸赫2

030001 太原,山西医科大学1;030001 太原,山西医科大学第一医院骨科2
徐彬,Email: xushu07017@163.com

摘要:胫骨远端骨折是创伤骨科较为常见的骨折。目前胫骨远端骨折的治疗仍是创伤骨科治疗的难点及热点,治疗方法很多,但没有哪一种固定的治疗方式可以覆盖所有类型的骨折,治疗的热点多是围绕最大限度地减少破坏血运及损伤软组织情况。随着AO及BO理念的不断完善,微创治疗已成为当前治疗的趋势。本文就近年来胫骨远端骨折应用较多的几种微创固定治疗方式作一综合阐述。

关键词:胫骨骨折; 内固定器; 骨折固定术,髓内

Study development for the treatment of extra-articular distal tibial fracture

Du Wujun1,2, Xu Bin2, Liu Chenhe

1Shanxi Medical University, Taiyuan 030001, China; 2Department of Orthopaedics, the First Hospital of Shanxi Medical University, Taiyuan 030001, China
Xu Bin, Email: xushu07017@163.com

Abstract:Distal tibial fracture is a common fracture in trauma department of orthopedics. So far, its treatment is still a hot pot and difficulty. There are many treatments about distal tibial fracture, but no one fixed treatment modality covers all sorts of fractures. And the hot pot of treatment centres on the reduction of destorying the blood supply and hurting soft issue in most largest extent. With the increasingly development of the aspect of AO and BO, minimally invasive fixation has been temporary trend of treatment. This article carried on a comprehensive explaination about some minimally invasive fixations more used in the treatment of distal tibia fracture in recent years.

Keywords:Tibial fractures; Internal fixators; Fracture fixation, intramedullary

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参考文献

  [1] Joveniaux P, Ohl X, Harisboure A, et al. Distal tibia fractures: management and complications of 101 cases[J]. Int Orthop, 2010, 34(4): 583- 588.

  [2] 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): A20-30.

  [3] Newman SD, Mauffrey CP, Krikler S. Distal metadiaphyseal tibial fractures[J]. Injury, 2010, 42(10): 975-984.

  [4] 黄家基, 蒙家辉, 施伟业, 等. 超远端胫骨髓内钉微创治疗胫骨远端干骺骨折[J]. 中国骨与关节损伤杂志, 2012, 27(8): 758-759.

  [5] Im GI, Tae SK. Distal metaphyseal fractures of tibia: a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation[J]. J Trauma, 2005, 59: 1219- 1223.

  [6] 纪方, 王秋根, 沈洪兴, 等. 经皮微创钢板固定技术(MIPPO)在胫骨近, 远端粉碎性骨折中的应用[J]. 中华创伤骨科杂志, 2004, 6(10): 1105-1108.

  [7] Ahmad MA, Sivaraman A, Zia A, et al. Percutaneous locking plates for fractures of the distal tibia: our experience and a review of the literature[J]. J Trauma Acute Care Surg, 2012, 72(2): E81- E87.

  [8] 楚宇鹏, 孔建中, 牟暇平, 等. 交锁髓内钉与LCP内固定治疗胫骨远端骨折的放射学及临床疗效比较[J]. 中国骨与关节损伤杂志, 2010, 25(12): 1080-1082.

  [9] 胥少汀, 葛宝丰, 徐印坎. 实用骨科学[M]. 北京: 人民军医出版社, 2004.

  [10] Xue D, Zheng Q, Li H, et al. Reamed and unreamed intramedullary nailing for the treatment of open and closed tibial fractures: a subgroup analysis of randomised trials[J]. Int Orthop, 2010, 34(8): 1307-1313.

  [11] Casstevens C, Le T, Archdeacon MT, et al. Management of extra- articular fractures of the distal tibia: intramedullary nailing versus plate fixation[J]. J Am Acad Orthop Surg, 2012, 20(11): 675-683.

  [12] Kuhn S, Hansen M, Rommens PM. Extending the indications of intramedullary nailing with the Expert Tibial Nail[J]. Acta Chir Orthop Traumatol Cech, 2008, 75(2): 77-87.

  [13] Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures[J]. J Orthop Trauma, 2011, 25(12): 736-741.

  [14] Ruiz AL, Kealey WD, McCoy GF. Implant failure in tibial nailing[J]. Injury, 2000, 31: 359-362.

  [15] Megas P, Zouboulis P, Papadopoulos AX, et al. Distal tibial fractures and non-unions treated with shortened intramedullary nail[J]. Int Orthop, 2003, 27: 348- 351.

  [16] Krettek C, Miclau T, Schandelmaier P, et al. The mechani-cal effect of blocking screws(“Poller screws”) in stabilizing tibia fractures with short proximal or distal fragments after insertion of small diameter intramedullary nails[J]. J OrthopTrauma, 1999, 13(8): 550-553.

  [17] Krettek C, Stephan C, Schandelmaier P, et al. The use of Poller screws as blocking screws in stabilizing tibial fractures treated with small diameter intramedullary nails[J]. J Bone Joint Surg(Br), 1999, 81(6): 963-968.

  [18] Hannah A, Aboelmagd T, Yip G, et al. A novel technique for accurate Poller(blocking) screw placement[J]. Injury, 2014, 45(6): 1011-1014.

  [19] 方玮, 马兆龙, 杨文贵, 等. 阻挡钉结合交锁髓内钉固定治疗胫骨远端骨折疗效分析[J]. 中国骨与关节损伤杂志, 2013, 28(8): 1126-1127.

  [20] 沈松坡, 强华, 赵尔弘. 专家型胫骨髓内钉治疗胫骨远端骨折的初期疗效[J]. 实用骨科杂志, 2016, 22(3): 229-232.

  [21] El Attal R, Hansen M, Rosenberger R, et al. Intramedullary nailing of the distal tibia illustrated with the Expert(TM) tibia nail[J]. Oper Orthop Traumatol, 2011 , 23(5): 397-410.

  [22] Ehlinger M, Adam P, Gabrion A, et al. Distal quarter leg fractures fixation: The intramedullary nailing alone option[J]. OrthopTraumatol Surg Res, 2010, 96(6): 674- 682.

  [23] Zhang J, Ebraheim NA, Li M, et al. External Fixation Using a Locking Plate: A Reliable Way in Treating Distal Tibial Fractures[J]. Journal of orthopaedic trauma, 2015, 29(11): e454-e458.

  [24] 梅正峰, 范顺武, 赵凤东, 等. 锁定钢板外固定治疗胫骨中下段骨折[J]. 中国骨伤, 2014(6): 458-460.

  [25] Kuhn S, Appelmann P, Pairon P, et al. A new angle stable nailing concept for the treatment of distal tibia fractures[J]. International orthopaedics, 2014, 38(6): 1255-1260.

  [26] Ristiniemi J. Flinkkila T, Hyvonen P, et al. RhBMP-7 accelerates the healing in distal tibial fractures treated by external fixation[J]. J Bone Joint Surg Br, 2007, 89(2): 265-272.

  [27] Vallier HA, Le TT, Bedi A. Radiographic and clinical comparisons of distal tibial shaft fractures(4 to 11cm proximal to the plafond): plating versus intramedullary nailing[J]. J Orthop Trauma, 2008, 22(5): 307-311.

(编辑:马超 收稿日期:2016-10-08)