改良双钢板法治疗复杂胫骨平台骨折

Dual plating for complex tibial plateau fractures

目的探讨改良双钢板法治疗复杂胫骨平台骨折的临床效果。方法2001年4～12月,采用改良双钢板法治疗复杂胫骨平台骨折21例,男12例,女9例;年龄20～66岁,平均45.2岁。按AO分型B型7例,C型14例;按Schazker分型Ⅳ型7例,Ⅴ型6例,Ⅵ型8例。用内外侧联合切口行改良双钢板固定SchazkerⅣ型采用前正中联合后内侧切口,后内侧用3.5系统有限接触加压钢板或1/2管型钢板固定支撑,前内侧以胫骨平台“T”型钢板固定;SchazkerⅤ、Ⅵ型采用前外侧联合后内侧切口,后内侧用3.5系统有限接触加压钢板或1/2管型钢板固定支撑,外侧以高尔夫棒型钢板固定。结果21例患者均获得随访,随访时间13～25个月,平均15.6个月。术后1个月患者膝关节屈曲80°～135°,平均100.0°;3个月膝关节屈曲90°～135°,平均117.1°。术后即刻胫骨平台内翻角(TPA)及胫骨平台后倾角(PA)度数与术后3个月比较,差异无显著性意义(均P>0.05)。术后3个月TPA及PA度数与术后1年比较,差异无显著性意义(均P>0.05)。术后1年膝关节HSS评分75～98分,平均89.6分。术后无一例发生切口皮肤坏死、深部感染、内固定松动及断裂。结论改良双钢板内固定为治疗复杂胫骨平台骨折提供了持续、稳固的固定,有效地防止了骨折再移位及膝关节力线改变,术后切口及软组织并发症少。

Objective A prospective study was conducted to evaluate the efficacy of modified dual plating for the complex fractures of tibial plateau. Methods From April to December 2001, 21 cases of comminuted, unstable tibial plateau fractures were treated with dual plating. The mean age of the patients was 45.2 years (20-66 years), which consisted of 12 males and 9 females. According to the AO classification, there were 7 of type B and 14 of type C; However, by the Schazker classification, 7 were of type Ⅳ, 6 of type Ⅴ, and 8 of type Ⅵ. The medio-lateral approach was used for the modified dual plating: the antero-medial approach combined with postero-medial approach was used for the fractures in Schatzker Ⅳ type, the 3.5 LC-DCP or 1/2 tubular plate was used to support the postero-medial key fragments; and the anterolateral approach combined with postero-medial approach was selected for the fractures in Schatzker Ⅴand Ⅵ types. The posterior fragments was buttressed as the above method, the lateral side was fixed with the 'Golf' shaped plate. Results All 21 patients were available at follow up with mean duration of 15.6 months (range, 13-25 months). The flexion of the knee achieved 100.0°(ranged from 80°-135°) at the 1st month postoperatively; then it was improved to 117.1°(range, 90°-135°) at the 3rd month. A comparison concerning the tibial plateau angle (TPA) and posterior slope angle (PA) immediately after operation with that both at the 3rd month and one year postoperatively, the difference was of no significance (P>0.05). According to the HSS system, the score was 89.6 (range, 75-98) averagely one year after operation. No any complications occurred, such as necrosis of the incision, deep infection, the loosening and breakage of the internal fixator. Conclusion The technique with modified dual plating for the complex fractures of the tibial plateau provides satisfactory function of the knee, it has many advantages, such as stable and durable fixation, avoiding the replacement and change of the knee mechanics, as well as diminish the problems about the incision and soft tissue.