胫骨平台合并胫骨上段骨折双钢板固定的手术治疗

Operative treatment of fracture of tibial plateau and upper segment with double buttress plates

目的:评估双钢板内固定治疗胫骨平台合并胫骨上段骨折的疗效。方法:41例Ⅲ型双髁胫骨平台骨折患者,双髁骨折塌陷均在10mm以上,同时伴有胫骨上段骨折。其中18例(A组)采用外侧支持钢板固定,男12例,女6例,年龄24～55岁,平均36.2岁;23例(B组)采用内外侧支持钢板固定,男15例,女8例,年龄22～51岁,平均35.8岁。术后CPM早期活动。结果:所有患者获得随访,随访时间1～3年,参照Merchant进行疗效评定,A组:优3例,良5例,可3例,差7例,优良率44%;B组:优13例,良8例,可2例,优良率91%。两组优良率差异有显著性意义(P<0.01)。结论:双钢板内固定为防止胫骨平台塌陷及骨块再移位提供了坚强的固定,术后不需外固定,更有利于早期活动、骨折愈合及功能恢复。

Objective:To evaluate the effect of fracture of tibial plateau and upper segment with double buttress plates.Methods:Forty-one patients with fracture of tibial plateau were both ankles type Ⅲ according to Hohl classification.Their cave-in of fracture was more than 10 mm,accompanying fracture of upper segment of tibia.Among them,18 cases (group A:male,12 cases;female,6 cases) were treated with internal fixation by medial buttress plates,with average of age 36.2 years (range from 24 to 55 years);23 cases (group B:male,15 cases;female,8 cases) were treated with double (medial and lateral) buttress plates,with average of age 35.8 years (range from 22 to 51 years).CPM were used early after operation.Results:All the patients were followed up from 1 to 3 years after operation.According to the standard of Merchant,group A:3 cases got excellent result,5 good,3 fair,7 poor,the rate of excellent and good was 44%;group B:13 cases got excellent result,8 good,2 fair,the rate of excellent and good was 91% (P<0.01).Conclusion:Double buttress plates offer a strong internal fixation for preventing from cave-in of tibial plateau and secondary displacement of fracture,moreover,external fixation was not needed after operation.It is more advantageous for the early activity,healing of fracture and functional recover.