Tejwani Nirmal C, Achan Pramod
NYU-HJD Department of Orthopaedic Surgery, New York University Medical Center, New York, New York, USA.
Bull Hosp Jt Dis. 2004;62(1-2):62-6.
High-energy proximal tibia fractures are complicated by soft tissue compromise and this may result in sub-optimal outcomes. There is a high association of open injuries, compartment syndromes, and vascular injuries with these bony disruptions. Surgical treatment of these injuries has been associated with significant complications such as infection, knee stiffness, malunion, loss of fixation, soft tissue failure, and amputations. The loss of fixation is an issue especially in the elderly, with failure associated with age more than sixty years, premature weight bearing, preoperative displacement, fracture fragmentation, and severe osteoporosis. The use of two-stage reconstruction for the treatment of distal tibia fractures has been successful in decreasing the complication rates, including wound compromise. The two stages involve: 1. stabilization of the injured limb with a bridging external fixator to allow the soft tissues to improve and recover and 2. definitive fixation for reconstruction of the articular surface and meta-diaphyseal fractures. The use of such a protocol has been proposed for high-energy proximal tibia fractures to decrease the high rate of soft tissue compromise associated with traditional open methods of treatment. The choice of definitive fixation may include plates, nails, or non-bridging external fixation.
高能胫骨近端骨折常伴有软组织损伤，这可能导致治疗效果欠佳。这些骨折与开放性损伤、骨筋膜室综合征及血管损伤密切相关。对这些损伤进行手术治疗会引发诸如感染、膝关节僵硬、畸形愈合、内固定失败、软组织坏死及截肢等严重并发症。内固定失败是一个尤其在老年患者中存在的问题，其失败与年龄超过60岁、过早负重、术前移位、骨折粉碎及严重骨质疏松有关。采用两阶段重建治疗胫骨远端骨折已成功降低了并发症发生率，包括伤口并发症。这两个阶段包括：1. 使用桥接外固定架稳定受伤肢体，以使软组织得到改善和恢复；2. 进行确定性固定以重建关节面和干骺端骨折。有人提出采用这种方案治疗高能胫骨近端骨折，以降低传统切开治疗方法所伴随的高软组织损伤发生率。确定性固定的选择可能包括钢板、髓内钉或非桥接外固定。
