Oztürkmen Yusuf, Caniklioğlu Mustafa, Karamehmetoğlu Mahmut, Sükür Erhan
Department of Orthopedics and Traumatology, Ministry of Health İstanbul Training and Research Hospital, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2010;44(4):262-9. doi: 10.3944/AOTT.2010.2406.
We aimed to evaluate the clinical and radiological outcomes of open reduction and internal fixation augmented with calcium phosphate cement (CPC) in the treatment of depressed tibial plateau fractures.
Twenty-eight knees of 28 patients [19 males and 9 females; mean age, 41.2 years (range 22-72 years)] who had open reduction and internal fixation combined with CPC augmentation were included in this study. Seventeen fractures were Schatzker type II, 5 were type III, 3 were type IV, 2 were type V, and 1 was type VI. CPC was used to fill the subchondral bone defects in all knees. Fixation of the fragments was done with screws in 3 knees (10%). Standard proximal tibial plates or buttress plates were used in 25 knees (90%) with an additional split fragment extending distally to achieve internal fixation. Full weight-bearing was allowed in 6.4 weeks (range 6-12 weeks) after surgery. Resorption of CPC granules was defined as the decrease in the size and density of grafting material on radiographs. Rasmussen's radiological and clinical scores were determined postoperatively. Functionality was assessed with Lysholm knee scoring system. Activity was graded with Tegner's activity scale.
Union was achieved in all patients with a mean follow-up of 22.2 months (range 6-36 months). There were no intraoperative complications. At the latest follow-up radiographs, resorption of the graft was observed in 25 knees (89%). Rasmussen's radiologic score was excellent in 17 patients (61%), good in 9 patients (32%), and fair in 2 patients (7%). Rasmussen's clinical score was excellent in 9 patients (32%), good in 18 patients (64%), and fair in 1 patient (4%). According to the Lysholm knee score, functional results were excellent in 16 patients (57%), good in 8 patients (29%), and fair in 4 patients (14%). Twenty-two patients (78%) achieved the preoperative activity level after surgery, and there was no significant difference between the mean preoperative and postoperative Tegner scores (4.11±0.68 and 4.04±0.64, respectively, p=0.161).
CPC is a safe biomaterial with many advantages in augmenting the open reduction and internal fixation of depressed tibial plateau fractures, including elimination of morbidity associated with bone graft harvesting, the unlimited supply of bone substitute, the optimum filling of irregular bone defects, and shortening of the postoperative full weight-bearing time.
我们旨在评估磷酸钙骨水泥（CPC）辅助切开复位内固定治疗胫骨平台塌陷骨折的临床和影像学结果。
本研究纳入28例患者的28个膝关节[男性19例，女性9例；平均年龄41.2岁（范围22 - 72岁）]，这些患者接受了切开复位内固定联合CPC辅助治疗。其中17例骨折为Schatzker II型，5例为III型，3例为IV型，2例为V型，1例为VI型。所有膝关节均使用CPC填充软骨下骨缺损。3个膝关节（10%）采用螺钉固定骨折块。25个膝关节（90%）使用标准的胫骨近端钢板或支撑钢板，并附加一个向远端延伸的劈开骨折块以实现内固定。术后6.4周（范围6 - 12周）允许完全负重。CPC颗粒的吸收定义为X线片上移植材料大小和密度的降低。术后测定Rasmussen影像学和临床评分。使用Lysholm膝关节评分系统评估功能。用Tegner活动量表对活动进行分级。
所有患者均实现骨折愈合，平均随访22.2个月（范围6 - 36个月）。术中无并发症。在最新的随访X线片上，25个膝关节（89%）观察到移植材料吸收。Rasmussen影像学评分：17例患者（61%）为优，9例患者（32%）为良，2例患者（7%）为可。Rasmussen临床评分：9例患者（32%）为优，18例患者（64%）为良，1例患者（4%）为可。根据Lysholm膝关节评分，16例患者（57%）功能结果为优，8例患者（29%）为良，4例患者（14%）为可。2-2例患者（78%）术后达到术前活动水平，术前和术后Tegner评分均值之间无显著差异（分别为4.11±0.68和4.04±0.64，p = 0.161）。
CPC是一种安全的生物材料，在辅助胫骨平台塌陷骨折的切开复位内固定方面具有诸多优势，包括消除与取骨相关的并发症、骨替代物供应不受限、能最佳地填充不规则骨缺损以及缩短术后完全负重时间。
