Department of Orthopaedics, Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China.
Arch Orthop Trauma Surg. 2014 Mar;134(3):383-8. doi: 10.1007/s00402-013-1916-1. Epub 2013 Dec 22.
INTRODUCTION: Tibial fractures with compromised soft tissue envelop may lead to significant complications. The optimal management of these injuries remains controversial. Recently, locking plate used as a definitive external fixator is attractive because it not only minimizes trauma to the soft tissues, but also overcomes the shortcomings of standard external fixators. The objective of this study was to evaluate the outcome of using locking plate as a definitive external fixator for treating tibial fractures with compromised soft tissue envelop. PATIENTS AND METHODS: A prospective series of 12 consecutive tibial fractures with compromised soft tissue envelop were treated using locking plate as a definitive external fixator. Of these patients, six were Gustilo and Anderson type IIIA, three were type II and three were closed fractures (AO/ASIF soft tissue injury classification IC4: 2, IC5: 1). Time to union, nonunion, malunion, leg shortening, range of motion and function for the knee and ankle, deep infection, pin tract infections were evaluated. RESULTS: The mean bone healing time was 37.8 weeks (range 20-56 weeks). Eventually, all of the fractures united. Most of the fractures healed in acceptable positions. There were no cases of deep infection. Pin tract infection was seen in 1 (8.3 %) patient, no loosening or failure of the external fixator was seen. At the most recent follow-up, the mean range of motion at the knee was extension 0° to flexion 135°, and the mean ankle range of motion was dorsi flexion 12° to plantar flexion 32°. All patients had excellent or good functional results and were fully weight bearing with a well-healed tibia at the final follow-up. CONCLUSION: The locking plate used as a definitive external fixator provided a high rate of union. The patients experienced a comfortable clinical course, excellent knee and ankle joint motion, satisfactory functional results and an acceptable complication rate. However, the stiffness of external locked plating is not clear, therefore, clinical recommendation on its practical use to reduce the risk of implant failure still need to be determined.
简介：伴有软组织损伤的胫骨骨折可能导致严重并发症。这些损伤的最佳治疗方法仍存在争议。最近，锁定钢板作为确定性外固定器具有吸引力，因为它不仅最大限度地减少了对软组织的创伤，而且克服了标准外固定器的缺点。本研究的目的是评估使用锁定钢板作为确定性外固定器治疗伴有软组织损伤的胫骨骨折的疗效。
患者与方法：前瞻性连续 12 例伴有软组织损伤的胫骨骨折患者采用锁定钢板作为确定性外固定器治疗。其中 Gustilo 和 Anderson ⅢA型 6 例，Ⅱ型 3 例，闭合性骨折 3 例（AO/ASIF 软组织损伤分类 IC4：2 例，IC5：1 例）。评估愈合时间、不愈合、畸形愈合、肢体短缩、膝关节和踝关节活动度和功能、深部感染、针道感染情况。
结果：平均骨愈合时间为 37.8 周（20-56 周）。最终所有骨折均愈合。大多数骨折愈合位置可接受。无深部感染病例。1 例（8.3%）患者出现针道感染，无外固定器松动或失败。末次随访时，膝关节活动度平均伸 0°至屈 135°，踝关节活动度平均背屈 12°至跖屈 32°。所有患者功能结果均为优或良，末次随访时胫骨愈合良好，均完全负重。
结论：锁定钢板作为确定性外固定器可获得较高的愈合率。患者临床过程舒适，膝关节和踝关节活动度良好，功能结果满意，并发症发生率可接受。然而，外固定锁定钢板的僵硬程度尚不清楚，因此，关于其实际应用以降低植入物失败风险的临床推荐仍需确定。
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