Gupta Ashish-Kumar, Sapra Rahul, Kumar Rakesh, Gupta Som-Prakash, Kaushik Devwart, Gaba Sahil, Bansal Mahesh Chand, Dayma Ratan Lal
Department of Orthopedics, Bhagwan Mahavir Hospital, New Delhi 110088, India.
Chin J Traumatol. 2015;18(6):326-31. doi: 10.1016/j.cjtee.2015.11.008.
The treatment of high-energy tibial condylar fractures which are associated with severe soft tissue injuries remains contentious and challenging. In this study, we assessed the results of Joshi's external stabilization system (JESS) by using the principle of ligamentotaxis and percutaneous screw fixation for managing high-energy tibial condylar fractures associated with severe soft tissue injuries.
Between June 2008 and June 2010, 25 consecutive patients who were 17e71 years (mean, 39.7), underwent the JESS fixation for high-energy tibial condylar fractures associated with severe soft tissue injuries. Out of 25 patients, 2 were lost during follow-up and in 1 case early removal of frame was done, leaving 22 cases for final follow-up. Among them, 11 had poor skin condition with abrasions and blisters and 2 were open injuries (Gustilo-Anderson grade I&II). The injury mechanisms were motor vehicle accidents (n=19), fall from a height (n=2) and assault (n=1). The fractures were classified according to Schatzker classification system.
There were 7 type-V, 14 type-VI and 1 type-lV Schatzker's tibial plateau fractures. The average interval between the injury and surgery was 6.8 days (range 2-13). The average hospital stay was 13 days (range, 7-22). The average interval between the surgery and full weight bearing was 13.6 weeks (range 11-20). The average range of knee flexion was 121°(range 105°-135°). The normal extension of the knee was observed in 20 patients, and an extensor lag of 5°-8° was noted in 2 patients. The complications included superficial pin tract infections (n=4) with no knee stiffness.
JESS with lag screw fixation combines the benefit of traction, external fixation, and limited internal fixation, at the same time as allowing the ease of access to the soft tissue for wound checks, pin care, dressing changes, measurement of compartment pressure, and the monitoring of the neurovascular status. In a nutshell, JESS along with screw fixation offers a promising alternative treatment for high- energy tibial condylar fractures associated with severe soft tissue injuries.
伴有严重软组织损伤的高能胫骨髁骨折的治疗仍存在争议且具有挑战性。在本研究中，我们通过运用韧带整复原理及经皮螺钉固定，评估了乔希外固定系统（JESS）治疗伴有严重软组织损伤的高能胫骨髁骨折的效果。
在2008年6月至2010年6月期间，25例年龄在17至71岁（平均39.7岁）的连续患者，接受了JESS固定治疗伴有严重软组织损伤的高能胫骨髁骨折。25例患者中，2例在随访期间失访，1例早期拆除了外固定架，最终22例患者纳入最终随访。其中，11例皮肤状况较差，有擦伤和水泡，2例为开放性损伤（Gustilo-Anderson I级和II级）。损伤机制包括机动车事故（n = 19）、高处坠落（n = 2）和袭击（n = 1）。骨折根据Schatzker分类系统进行分类。
有7例Schatzker V型、14例Schatzker VI型和1例Schatzker IV型胫骨平台骨折。受伤至手术的平均间隔时间为6.8天（范围2至13天）。平均住院时间为13天（范围7至22天）。手术至完全负重的平均间隔时间为13.6周（范围11至20周）。膝关节平均屈曲范围为121°（范围105°至135°）。20例患者膝关节伸直正常，2例患者存在5°至8°的伸膝滞后。并发症包括浅表针道感染（n = 4），无膝关节僵硬。
带拉力螺钉固定的JESS结合了牵引、外固定和有限内固定的优点，同时便于对软组织进行伤口检查、针道护理、换药、测量骨筋膜室压力以及监测神经血管状况。简而言之，JESS联合螺钉固定为伴有严重软组织损伤的高能胫骨髁骨折提供了一种有前景的替代治疗方法。
