I've been working 9 hours a day at the computer, and I've had back pain for over a year. 19 year old girl.

The intervertebral disc consists of the annulus fibrosus, nucleus pulposus and hyaline cartilage plate: ① annulus fibrosus. Composed of fibrous soft tissue, the fibers are arranged in concentric rings, the ring of fibers in the vertebral body diagonal, each ring of fibers and its neighboring fibers diagonal in the opposite direction, cross into the angle, which is conducive to the spinal column can be a greater range of activities in all directions, but at the same time, limit the spinal column over-rotation. The fibers near the center ring the lamina, starting from the cartilaginous plate and traveling obliquely outward, bypass the medullary loss and then toward the center and end at the contralateral cartilaginous plate, giving the nucleus pulposus an oval shape. The outermost fibers are fused to the anterior and posterior longitudinal ligaments. The peripheral fibers of the annulus fibrosus, which cross the edge of the cartilaginous plate into the bone of the vertebral body, are called Sharpey's fibers. The deeper fibers end at the cartilaginous plates at the ends of the intervertebral disc. Therefore, the intervertebral disc and the vertebral body are firmly connected, and under normal circumstances, it is impossible to slide, the annulus fibrosus is thick in front and thin in the back, and there is a strong and broad anterior longitudinal ligament in front to strengthen it, but the posterior longitudinal ligament is weak. The nucleus pulposus. The nucleus pulposus is a gelatinous substance with a water content of up to 80%. However, it decreases with age. Newborns accounted for 88%, 70% of the adult period and gradually replaced by fibrous tissue, so the adult nucleus pulposus and the annulus fibrosus have no clear demarcation. The nucleus pulposus is not in the center of the intervertebral disc, but in the posterior part of the intervertebral disc. The transparent cartilage plate, which is related to the growth of the height of the vertebral body, prevents the nucleus pulposus from protruding into the cancellous bone of the vertebral body, and the intervertebral disc, in addition to the abovementioned connecting role, is more important in absorbing shock and making the spinal column elastic. However, the nucleus pulposus cannot be compressed because it contains a large amount of water, and it deforms and moves very little in the annulus fibrosus when the spine is in motion. The intervertebral discs are under pressure even when not weight-bearing, due to the intervertebral ligaments and the annulus fibrosus. The pressure on the nucleus pulposus in the lumbar region is approximately 13.5 kg when lying down, and 13.5 kg plus the sum of the weight of the torso in the plane of the discs when standing upright. During physical activity or weight bearing, the pressure can be hundreds of kilograms. The nucleus pulposus also has a certain permeability, during the daytime due to labor or weight pressure to make the fluid in the nucleus pulposus extravasation, and at night after lying down the fluid into the nucleus pulposus, so that a person has to get up early in the morning to be higher than before going to bed about 1.25cm. The intervertebral disc has a blood supply in the fetal period, but the nutrient blood vessels begin to occlude at 8 months, and by the age of 20 years has been completely occluded, the nutrition of the intervertebral disc is mainly dependent on the vertebral blood vessels and tissue fluid infiltration, which may also be the reason why the intervertebral discs are prone to degenerative changes.

Pathology

The pathophysiology of the intervertebral discs continues to develop after birth and reaches its peak at about 20 years of age, after which it gradually begins to degenerate, with the nucleus pulposus gradually replaced by fibrous tissue and chondrocytes, and with a gradual decrease in fluid content. The age at which degeneration begins varies from person to person, some people are a little later, but often in the main weight-bearing parts of the spine, the change is obvious and progresses quickly, and finally the nucleus pulposus can be completely replaced by fibrous tissue and chondrocytes, and the height of the intervertebral disc is reduced. The development of the annulus fibrosus also ends at about 20 years of age, and the degeneration may begin earlier than the nucleus pulposus. Although the annulus fibrosus is very solid, but in strenuous exercise can cause the neighboring layers of fibers at the crossroads of each other friction, resulting in fibrous degeneration and hyaline degeneration, and finally can cause the annulus fibrosus to rupture, and in the fibrous layers of the interlayer centripetal cracks, such cracks are generally more in the annulus fibrosus of the posterior outer, nucleus pulposus can be protruding from the cracks to the age of 40 years old and above, the annulus fibrosus of the degeneration of the annulus fibrosus is more pronounced. In the cartilage plate, there are residual blood vessels from the vertebral body into the intervertebral disc, for a weak part of the intervertebral disc material can also be herniated into the vertebral body through the pipe, which is the origin of Schmorl's nodes.

On the basis of degenerative changes in the intervertebral disc tissue, if it is subjected to unbalanced pressure, the annulus fibrosus can be ruptured at the weak point, and the nucleus pulposus can bulge out from the rupture point, which is clinically known as bulging, and if it further protrudes, it is known as herniation and prolapse, and the protruding portion of the nucleus pulposus and the broken annulus fibrosus protrudes into the vertebral canal and presses on the corresponding nerve roots and cones, and then serious symptoms will occur.

Herniation can occur when the lumbar intervertebral disc is subjected to sudden or continuous pressure. For example, bending over to carry heavy objects, lifting heavy objects with poor cooperation with other people, lumbar twisting is too large, and the buttocks sit on the ground when falling. It is not common that the herniation is caused by direct trauma to the lumbar region, but it is not uncommon that the herniation is caused by washing the face, washing clothes, or even coughing or sneezing. The cause is unknown in about 30% of patients. When the nucleus pulposus of young people is in a semi-liquid state, the protruding tissue can be absorbed, and the symptoms are relieved. However, if the protruding tissue is the nucleus pulposus which has hyaline cartilage or fibrocartilage degeneration, it can not be absorbed and results in the long term compression of the nerve root, and the symptoms do not subside, and then adhesions are produced around the nerve root (Figure 100-27), and at this time even if the protruding material is absorbed in the end, the pain is often still left behind. Degeneration of the intervertebral discs, instability of the intervertebral joints themselves, coupled with the laxity of the anterior and posterior longitudinal ligaments caused by a reduction in the height of the intervertebral discs, and the structural changes of the posterior joints, the vertebral body will often move back and forth during lumbar activities, and the vertebral body edges and the small articular eminences will produce bony encumbrances, and the ligamentum flavum will be hypertrophied, and so on, and these changes themselves, can also cause compression of the nerve root, and so, in the later stage of the patient, the cause of symptoms is not a single reason. Therefore, in the later stage of the disease, the cause of symptoms is not a single cause. Most lumbar disc herniations are unilateral, but a few are bilateral, and sometimes the central herniation compresses the nerve roots on both sides at the same time. Because of the different locations of the herniated material, the clinical symptoms are also different, due to the nerve root from the dural sac to send down a segment from the intervertebral foramen, so lumbar 4, 5 disc herniation for the compression of lumbar 5 nerve root, and lumbar 5 sacral 1 disc herniation compression is sacral 1 nerve root.

Diagnostic note

Diagnosis and differential diagnosis According to the history and signs and X-ray manifestations, the diagnosis of lumbar disc herniation is generally not difficult. In particular, the diagnosis rate is quite high through imaging or CT or MRI examination. However, it should be differentiated from the following diseases.

1, lumbar spine tuberculosis: can produce lumbar pain and lower limb pain, X-ray film in the early stage of the manifestation of intervertebral space stenosis, sometimes with lumbar intervertebral disc herniation will be confused. Generally, lumbar spine tuberculosis is more common in adolescents, often with low-grade fever, rapid blood sedimentation, sometimes cold abscesses can be detected, and bone destruction can be seen after the progression of the disease.

2, lumbar spine tumor: including primary and secondary, generally have bone destruction, isotope examination can be distinguished.

3, cauda equina tumor: must be identified, because the two diseases are sometimes confused with each other. However, the cauda equina tumor often has no obvious low back pain, the symptoms of progressive aggravation (non-intermittent), the pain is prominent at night, and the symptoms are aggravated by bed rest. There is decreased sensation in the saddle area and difficulty in urination, and cerebrospinal fluid protein is increased. Spinal myelography can make a clear diagnosis, and MRI also has high discriminatory power.

4, the arch root collapse and spondylolisthesis, generally X-ray film can be distinguished, but sometimes the two diseases can exist at the same time.

5, lumbar spinal stenosis: sometimes lumbar disc herniation is the cause of spinal stenosis, but the real lumbar spinal stenosis should not include lumbar disc herniation (see lumbar spinal stenosis chapter). In spinal stenosis with predominantly sciatica manifestations, it is more difficult to distinguish between the two, but the sagittal and transverse diameters of the spinal canal can be known from spinal canal measurements on plain radiographs, myelography, and CT or MRI.

6, ankylosing spondylitis: the lesion is progressive, early can have lumbago sciatica. But the beginning of often in bilateral sacroiliac joints, blood sedimentation fast, the development of the disease can be seen after the small joint synapse fuzzy or fusion. Later the spine has bamboo-like changes.

7, intervertebral discitis: mostly occurring in children, adults are rare, adult onset often have a history of surgery, there is a systemic inflammatory manifestations, X-ray in the early performance of the intervertebral space stenosis, but later can be seen in the two vertebrae relative to the edge of the widening of the final vertebral body fusion.

Clinical manifestations

Clinical manifestations of this disease is a disease of young adults, preferably in the age of 30 to 50 years old, this is because of the intensity of the activities of this age group, and the discs have degeneration. More men than women about 10:1; the left side more than the right side, probably because most people like the right side of the force, so the right side of the lumbar and back muscles are more developed, tension, the pressure of the discs to the left side of the left side to herniate in the left side of the reason. The lower lumbar spine is the most common herniated parts, some statistics up to 98%, and lumbar 4, 5 accounted for 60%.

Common signs of posterior disc herniation

(1) Lumbar pain and lower extremity radiating pain This is the most common symptom of lumbar disc herniation. This is the most common symptom of lumbar disc herniation. Generally, lumbar pain comes first, and then leg pain arises after a certain period of time, and some people also have lumbar pain and leg pain immediately when a trauma occurs. The pain is generally more severe, affecting life and work, and in severe cases, bedridden, bending, coughing, sneezing, defecation will aggravate the pain. Symptoms are mostly unilateral, sometimes it will turn to the opposite side that is, both sides have symptoms, severe cases can appear difficulty in urination and loss of sensation in the saddle area, bipedal paralysis, the symptoms tend to be relieved after resting, sometimes light and sometimes heavy, but often the interval between relieving gradually become shorter and the pain is aggravated. A few patients start with leg pain without low back pain.

(2) limited lumbar activity, lumbar muscle protective spasm, lumbar stiffness, all directions of movement is inconvenient, up and down the bed, sitting up are difficult. The pain is worse when doing lumbar extension, which can be explained by the fact that the posterior extension squeezes the herniated material into the spinal canal, and the ligamentum flavum is lax and anteriorly protruding, which increases the compression effect on the nerve root.

(3) Scoliosis, known as "sciatica scoliosis," (Figure 100-28) is characterized by the majority of patients favoring the healthy side and a few favoring the affected side. It is generally believed that this is related to the relative position of the protrusion and the nerve root, such as the protrusion in the nerve root of the outside of the upper side of the curved to the healthy side, while in the inside of the lower side of the curved to the sick side. The reason for this is that the body tries to avoid the compression of the protrusion on the nerve root.

(4) Lumbar pressure and radiating pain The pressure points of this disease are often on both sides of the midline, and are characterized by pressure and pain radiating to the lower limbs, with a positive rate of up to 90%, which can be used as a strong basis for diagnosis and localization.

(5) Straight leg elevation test (Lasegue's sign), etc. This is an important test to diagnose the disease. This is an important test for the diagnosis of the disease. Make the patient lie on his back, make the knee straight, the lower limb slowly raised, normal up to about 90 °, generally first lift the healthy side so that the patient is prepared, and then lift the affected side, often less than 90 °, this is by the protruding material on the nerve root compression of the severity of the degree of, in severe cases, lifting less than 30 ° that is, the pain. In severe cases, pain occurs when the herniation is less than 30°. Then, before the lower limb is elevated to the point where pain occurs, the examiner uses his hands to make the foot dorsiflexed, and pain occurs in this way, which is called the Bragard's sign or the reinforcement test. In the past, it was thought that a negative straight-leg raise test could exclude the lumbar herniated disc, but it has been found that in a very small number of cases, the straight-leg raise test is positive. Sometimes there is pain on the affected side when lifting the healthy side, which is called a positive Lewen's sign. Another method of examination is called the sitting nerve root test, in which the patient sits, straightens the knee and gradually raises it, observing the degree of elevation, which also pulls the sciatic nerve. The femoral nerve pull test, also known as the heel and buttock test, the patient lies down and pushes the heel towards the buttock, if the femoral nerve is compressed, the patient will feel pain. In addition, can also be done to flex the neck test, the patient lying on his back, the examiner pressed one hand on the chest, the other hand will raise the head, positive people appear lower limb pain, which is also the cause of the nerve root is pulled. Compression of the jugular vein increases the intradural pressure, which aggravates the pressure of the protrusion on the nerve root and worsens the pain, which is called Naffziger's sign.

(6) Sensory changes Sensory changes may occur in the skin segments innervated by the compressed nerve root. Sensory hypersensitivity, followed by dullness or loss of sensation, lumbar 5 nerve root compression sensory changes in the lateral calf and the dorsum of the foot, while the sacral 1 compression in the small toes and the lateral foot, which has a certain reference value for the localization of the protrusion, but is not certain.

(VII) Hypokinesia Involvement of the femoral nerve affects the quadriceps muscle strength. Involvement of the lumbar 5 nerve root manifests as hypomobility of the extensor hallucis longus muscle, and in severe cases, it can also affect the dorsal extensor muscles of the foot, which is also of value in localization.

(8) Tendon reflexes: In femoral nerve compression, knee reflexes are reduced, and in sacral 1 nerve root compression, Achilles tendon reflexes are reduced, which is also valuable for localization.

(ix) Laboratory tests Generally there are no abnormal findings, a few patients have a slight increase in cerebrospinal fluid protein.

Laboratory examination

X-ray performance of the first routine X-ray examination, the purpose of which is to ① except for other spinal lesions such as tuberculosis, tumors, etc., ② observation of indirect signs of disc disease: such as spinal scoliosis, narrowing of the intervertebral space, vertebrae and Xiaoguanchuanjiu and degenerative changes, as well as the presence of slipped discs, and so on. Because the intervertebral disc is not visualized, it is not possible to diagnose ruptured disc and herniated nucleus pulposus from the plain film, and it is necessary to do imaging or other methods of examination.

(I) imaging methods such as ① myelography: iodine-containing contrast medium is injected into the subretinal space to observe its flow and the presence or absence of filling defects, (Figure 100-32) the diagnostic rate is quite high (60-95%). However, there are problems such as pancreatic complications, irritation of the contrast medium, and nerve root adhesions (see the chapter on cervical spondylosis). Nucleus pulposus imaging: injecting the contrast medium directly into the nucleus pulposus, the diagnostic rate is also high (68.9-91%), but it is difficult to operate, and the injection of the contrast medium often produces severe sciatica, which is less frequently used nowadays. Epidural contrast: injecting contrast into the epidural, the contrast is in the form of a dotted line, like a tree branch hanging in the snow, which can depict the outline of the epidural cavity and the direction of the nerve root. In the hands of experienced physicians, the diagnostic rate can reach (98.2-100%), and the contrast is absorbed quickly, and no intra-arachnoid adherence will occur, etc., but it is not easy to operate, and it is difficult to reasonably interpret the performance of the contrast. There are two methods, one is to inject the contrast into the spinous process, and the other is to cannulate into the lumbar vein to inject the contrast, the disadvantage of which is the need for special X-ray equipment and the development of the image is not very clear.

(2) CT and magnetic **** vibration imaging (MRI) has been widely used in spinal surgery, with the patient without pain, clear imaging, disc and nucleus pulposus protrusion, as well as the relationship with the nerve root at a glance, the correct rate is high. However, the equipment of these two methods is complicated and the examination cost is expensive. Therefore, the way of special examination should be based on specific conditions.

Treatment instructions

After treating a herniated disc, the nucleus pulposus can gradually shrink and be absorbed, and the broken part of the annulus fibrosus can be replaced by fibrous tissue, so that the pressure on the nerve root can be reduced and the symptoms gradually relieved, and therefore, first-time offenders can often be cured by non-surgical treatment. However, because the defect on the fiber ring is repaired, it is always a weak link, once it is damaged again, the pressure in the disk increases, it can occur again and again, so the symptoms are repeated, and it is getting heavier and heavier, and the cycle is getting shorter and shorter, some of the first time the protrusion is serious, the pressure on the nerve root is big, and the symptoms can be so serious that the patient can't bear it, and the adhesion between the epidural cavity and the nerve root caused by the protruding material in some patients, makes the symptoms never disappear completely. The symptoms never completely disappear. All these variations make the treatment of disc herniation varied, and the efficacy is inconsistent and opinions are divided.

(I) non-surgical treatment

1, absolute bed rest is the simplest and most effective treatment, emphasizing the word "absolute", that is, eating and defecation should not leave the bed, the hip and knee joints can be slightly flexed in order to reduce the pressure in the intervertebral discs, but also to reduce the pressure on the nerve root at the same time. Most patients who have a first attack get symptomatic relief within 3 weeks.

2. The purpose of pelvic traction is to widen the rupture opening of the disc so that the herniated nucleus pulposus can be retracted. However, the fact is that the rupture opening is small and irregular, and the nucleus pulposus is broken, so it is not possible. Therefore, I am afraid that its therapeutic effect is still the cause of bed rest.

3, massage and massage therapy is generally considered to be a very effective method, especially for first-time sufferers. Its therapeutic mechanism may be to make the nucleus pulposus back or change the position of the protrusion and the nerve root relationship, the result can reduce or eliminate the compression of the nerve root, but has not been able to confirm. The method is that the patient lies on his side, the doctor puts one hand on the patient's shoulder and the other on the iliac crest, wrenches the shoulder back and pushes the ilium forward at the same time, and suddenly twists the lumbar region with a steady force, which can often be smelled, and the symptoms can often be relieved dramatically (Fig. 100-34). In acute patients, massage, etc., may be performed. Recently there have been reports of the so-called big tui na under general anesthesia, although there is a certain degree of efficacy, but due to the anesthesia so that the muscles are completely relaxed, the improper use of force will cause unnecessary damage, but aggravate the symptoms or even the occurrence of cauda equina paralysis, etc., the consequences of which are serious, and should not be carried out.

After the symptoms have been relieved by non-surgical treatment, you should wear a waist cuff to protect your waist from further injury. However, lumbar muscle exercise is the most important.

(2) chemical nucleus pulposus

Enzymes that can dissolve cartilage are injected directly into the intervertebral discs to destroy the hydrophilic properties of the nucleus pulposus, and cartilage mucus proteins are broken down to produce mucopolysaccharides that are excreted by the urine to reduce the pressure inside the discs. Chymopapain is commonly used. Because of the simple operation, it has been widely used in foreign countries, and the efficacy can reach 70-80%. If nucleolysis fails, surgery can still be performed, and it is also applicable to cases of surgical failure. However, it has been banned in the United States due to reports of death due to allergic reactions and arachnoiditis and paraplegia in a small number of patients.

(3) Surgery

The indications for surgery are: (1) those who have been ineffective in regular non-surgical treatment; (2) those who have frequent attacks affecting their lives and workers even though non-surgical treatment is effective; (3) those whose symptoms are severe and intolerable to the patient, and who cannot be relieved by painkillers; and (4) those who have sensory disturbances in saddle area and difficulty in urination. We do not advocate long-term massage and acupressure treatment, the reason is that it can cause adhesions around the nerve root, the nerve root compressed for a long time will be degenerated as well as can make the vertebral plate and ligamentum flavum thickening and lead to medical spinal stenosis. Therefore, if non-surgical treatment is ineffective, surgery should be performed in a timely manner.

The goal of surgery is to remove the protruding nucleus pulposus and eliminate the pressure on the nerve root. There are many surgical approaches, including posterior access, "windowing" into the spinal canal, and hemilaminectomy or total laminectomy exposure. All three methods have their advantages and disadvantages. The less the laminectomy, the less the impact on spinal stability, but the smaller the scope of exposure, it is difficult to completely remove the herniation, or even make the herniation can not be found and missed. It is generally believed that if the tuberosity protrusion is not removed, it has little effect on spinal stability and can be compensated for by postoperative lumbar muscle exercises, but if the tuberosity protrusion is removed during surgery to extend the exposure, a transverse fusion must be added to maintain stability. In addition, some scholars have reported that anterior (abdominal or extraperitoneal) resection of the intervertebral disc, along with interbody fusion, is beneficial to the protection of spinal stability, but the main disadvantage is that the herniated material can not be seen to compress the nerve root, and can only be blindly resected all of the intervertebral discs, and the difficulty of exposure, the deep field of the operation as well as the possibility of damage to the surrounding blood vessels and other structures, has not been widely used.

The complications of surgery are ① rupture of the dura mater. This can be repaired, but if the suture is not tight, there is a possibility of cerebrospinal fluid leakage. Nerve root injury, which is mostly caused when separating adhesions, can usually be recovered. A few are cut off by the knife, which should be avoided. Intervertebral disc surgery is more delicate, requiring the operator to have a certain degree of operating experience, and should not be carried out hastily. ③ Retroperitoneal vascular injury and intestinal injury. These are in the removal of protrusions, into the knife is too deep or in the scratching, clamping too deep due to the literature has been reported, which should be noted. Regarding the question of how many gaps should be explored surgically and whether both sides should be explored, we believe that this should be done in conjunction with the preoperative data. We believe that this should be combined with the preoperative data. If there are bilateral symptoms, both sides should be explored, but if one side is found to have herniation on the opposite side, the opposite side should also be explored. Since the majority of lumbar disc herniation occurs in lumbar 4, 5 and lumbar 5 sacral 1, many people advocate routine exploration of these two interspaces, which is especially suitable for those who have not done imaging before surgery, such as preoperative imaging, CT, MRI and other investigations, and herniated planes and clinical symptoms are consistent with the person, you can consider exploring the herniated interspace only. In conclusion, the surgery of intervertebral disc herniation is not a very simple problem and should be carefully studied before surgery.

Meng's fracture external fixation brace for tibial plateau fracture

Our hospital applied Meng's fracture external fixation brace for the treatment of tibial plateau fracture between 1991 and 1992, and received better results, which are summarized as follows:

Clinical data

Age and gender:Minimum age: 24 years old, Maximum age: 52 years old, 8 cases of male, 2 cases of female. Injury to consultation time:the fastest 2 hours, the longest 33 days. Fracture type:2 cases of lateral plateau split fracture, 1 case of medial plateau split fracture, 3 cases of lateral plateau split collapse, (1 case of collapse 0. 5CM, 2 cases of collapse 1CM), 4 cases of bilateral plateau comminuted fracture (2 cases of plateau collapse 1CM, 2 cases of plateau collapse 1. 5CM).

Treatment method

1. Reduction: Fractures with no or slight displacement do not require reduction, and if the fracture block is significantly displaced bilaterally or collapses more than 1CM, then reduction is required. Generally, epidural anesthesia is used, the patient is placed in supine position, the blood in the joint is extracted first, such as epicondylar fracture, an assistant holds the lower end of the thigh of the affected limb, and another assistant holds the lower end of the lower leg, and the knee joint is straightened in the inversion position for drawing and stretching and traction, by which the knee and the lateral collateral ligament are strained and the lateral condyles are pulled, and the operator pushes and extrudes with the palms of both hands from both the inner and outer side of the upper end of the tibia toward the central part of the knee to make the bone fragments closer to each other. The medial condylar fracture is reset in the same way as above, except that the knee joint is turned outward when traction is applied. For bicondylar fracture, the knee joint is placed in the neutral position when traction is applied, so that both condyles are subjected to the same traction force. If the fracture is old, or if the fracture is displaced, and cannot be reset by manipulation, it can be pried out with Kirschner's pin under fluoroscopy, and if the displaced fracture fragments still cannot be realigned, then an open reset should be carried out, and the displaced or collapsed fracture fragments should be pried out during the operation, and the bony defects underneath it can be filled in with cancellous bone, and fixed with Kirschner's pin.

2. Fixation: After the fracture is reset, the fracture is fixed with an external fixation frame, and a 3MM Kirschner's pin is threaded from the inside out at the lower end of the femur at the supracondylar region. And then in the lower end of the tibia about 4 transverse fingers on the tip of the epicondyle from the outside to the inside against the anterior edge of the fibula through a 3MM Kirschner's needle, connected to the external fixation bracket, rotate the screws on the stress bar for traction, when the feeling of under the hand there is a certain degree of resistance after stopping traction, sealing the eye of the needle, the affected limb is elevated, and the knee joint maintains a slightly flexed position. Postoperative observation of the needle channel at any time, such as the patient's general condition is good, the second day can support the crutches down to the ground without weight-bearing walking. Active exercise quadriceps contraction, generally with external fixation bracket fixed, the affected limb can be 30 degrees of knee flexion activities.

In this group of cases, except for one case of open restoration, all other cases were restored by some methods, and all of them were treated with external fixation frames. After 8 to 12 weeks of operation, the external fixation bracket was removed by radiographs depending on the healing of the fracture. Generally, weight-bearing was done after 16 weeks.

Treatment results

1, excellent, bony healing, normal extension and flexion of the knee joint, no pain in activities, and return to work in 7 cases.

2, good, bony healing, knee flexion up to 110 degrees, walking without pain, can resume the original work 2 cases.

3. 1 case with bony healing, knee flexion up to 90 degrees, instability or pain in the knee joint, and some effect on physical labor.

4, poor, fracture deformity healing, knee flexion less than 90 degrees, knee joint often have pain, can not adapt to physical labor (no poor cases in this group).

Experience

Through the application of external fixation for platform fracture treatment, it is realized that as long as the platform collapse is not more than 1CM, it should be treated with external fixation, and it can be used for early activities, so that the fracture healing process according to the femoral condylar shape, and re-modeling into a shape, no matter for the unicondylar cleavage fracture or bicondylar comminuted fracture, it can be obtained a stable, painless, and functionally intact joints. For some old fractures and large collapsed fractures, the external fixation frame can still be applied after open reset. It has the advantages of easy fixation, small damage and firm fixation. Combination of Chinese and Western medicine treatment of fracture is characterized by the combination of motion and static. Meng's fracture external fixation frame for platform fracture treatment provides a biomechanical basis for early knee joint movement. After clinical observation, it is realized that after the affected knee is connected to the external fixation frame, the knee joint is in the state of traction force, and then the knee joint is in the position of straightening or slight flexion when it is at rest. When the rope muscle contraction, the knee joint will overcome the traction force of the external fixation bracket and flexion, when the rope muscle contraction force is greater, the greater the angle of flexion, the knee joint by the traction force with the increase. When the knee flexion to a certain angle (about 30 degrees of flexion), the visible Kirschner's needle began to bend, at this time the muscle contraction force is greater than the traction force, the knee joint joint surface is likely to bear the pressure, so in the functional exercise to flexion of not more than 30 degrees is appropriate, can make the knee joint in the role of traction to carry out activities, to prevent internal and external adhesion of the joint, and to provide a basis for the functional recovery in the future. And due to the application of external fixation frame treatment, it can leave the bed earlier, especially for the elderly patients, which can reduce the long-term bed-ridden comorbidities. Since there are still few cases of platform fracture treated by this method, it needs to be summarized and improved continuously. However, there is no doubt that this treatment is a good way to treat plateau fracture. I hope that the same way to put forward corrections.