Jöckel J A, Fischer J, Kraus M, Gebhard F, Röderer G
Orthopädie, Spital Schwyz, Schweiz.
Z Orthop Unfall. 2013 Feb;151(1):85-92. doi: 10.1055/s-0032-1328204. Epub 2013 Feb 19.
Surgical treatment of tibial head fractures can be challenging due to the close anatomic relationship to the knee joint which can be affected including its intraarticular structures. Frequently, soft tissue damages are present which can have a strong impact on the planning and choice of surgical technique. An important therapeutic requirement is the anatomic reconstruction and high primary stability to allow early functional treatment. The aim of the present study was to describe a recent locking device and its surgical technique and to analyse the early results.
The Non-Contact-Bridging Plate for the proximal tibia (NCB® PT, Zimmer Inc.) features a polyaxial locking mechanism which allows both compression and locking with the same screw. The system can be applied both minimally invasively and open. 36 patients (16 female, 20 male; average age 53 years) with three type A, 21 type B and 12 type C fractures according to the AO classification were treated. In 22 cases the system was applied open and in 14 minimally invasively. Clinical and radiological follow-up was obtained at 6 weeks, 3, 6 and 12 months.
The handling of the system turned out to be straightforward after an initial learning curve. Implant failure was not detected in our sample. The minimally invasive technique can be beneficial in cases of severe soft tissue damage, but must not compromise the quality of reduction. The functional result at 1-year follow-up using a knee score was good or very good and comparable to the literature. The rate of general surgical complications was 11 % (haematoma, superficial or deep wound infection). Implant-related complications were not detected. At the 3-months' follow-up 44 % and at the 12-months' 100 % of the fractures were healed on X-ray.
The NCB PT plate offers a broad variety of treatment options due to the specific locking mechanism and the fact that it can be applied both minimally invasively and open. In cases of intraarticular involvement the application of compression and locking with the same screw turned out to be very beneficial. The primary stability of the system allows early functional treatment. Clinical results and complication rates of the present study are comparable to those in the literature.
由于胫骨近端骨折与膝关节的解剖关系密切，包括关节内结构可能受到影响，其手术治疗具有挑战性。软组织损伤也很常见，这可能对手术技术的规划和选择产生重大影响。重要的治疗要求是进行解剖重建并实现高初始稳定性，以便进行早期功能治疗。本研究的目的是描述一种新型锁定装置及其手术技术，并分析早期结果。
用于胫骨近端的非接触桥接钢板（NCB® PT，捷迈公司）具有多轴锁定机制，同一枚螺钉即可实现加压和锁定。该系统既可以微创方式应用，也可以开放应用。根据AO分类，对36例患者（16例女性，20例男性；平均年龄53岁）进行了治疗，其中A型骨折3例，B型骨折21例，C型骨折12例。22例采用开放方式应用该系统，14例采用微创方式。在术后6周、3个月、6个月和12个月进行了临床和影像学随访。
经过最初的学习曲线后，该系统的操作变得简单直接。在我们的样本中未检测到植入物失败。对于严重软组织损伤的病例，微创技术可能有益，但绝不能影响复位质量。使用膝关节评分进行1年随访时，功能结果良好或非常好，与文献报道相当。一般手术并发症发生率为11%（血肿、浅表或深部伤口感染）。未检测到与植入物相关的并发症。在3个月随访时，44%的骨折在X线片上愈合，在12个月随访时，100%的骨折愈合。
由于其特殊的锁定机制以及既可以微创应用也可以开放应用的特点，NCB PT钢板提供了多种治疗选择。在关节内受累的情况下，使用同一枚螺钉进行加压和锁定被证明非常有益。该系统的初始稳定性允许早期功能治疗。本研究的临床结果和并发症发生率与文献报道相当。
