加强型单环与单臂Hybrid外固定器结合有限内固定治疗复杂胫骨平台骨折

Reinforced bar-ring Hybrid external fixator combined with limited internal fixation for complex fractures of tibial plateau

目的探讨使用加强型单环与单臂Hybrid外固定器结合有限内固定治疗复杂胫骨平台骨折的手术方法及临床疗效。方法回顾分析21例复杂胫骨平台骨折的临床特点、手术方法及临床疗效。本组男15例,女6例；年龄22～75岁,平均38．9岁。致伤原因：交通伤11例,坠落伤7例,重物砸伤3例。采用Schatzker分型：Ⅴ型骨折13例,Ⅵ型骨折8例结果随访10～24个月,平均15．9个月,所有患者均骨性愈合。根据Merchant的评分标准,优7例,良10例,可4例,优良率达81%。结论加强型单环与单臂Hybrid外固定器结合有限内固定技术能减少并发症,避免膝关节僵硬,是治疗复杂胫骨平台骨折的有效治疗方法。

Objective To introduce the experience and analyze the clinical outcome of application of reinforced bar-ring hybrid external fixator combined with limited internal fixation for complex fractares of tibia plateau in patients. Methods From Aug. 2002 to Feb. 2005, 21 patients with complex fractures of tibial plateau were treated with reinforced bar - ring hybrid external fixator combined with limited internal fixation. According to Schatzker classification, there were 13 patients with type Ⅴ fracture and 8 with type Ⅵ fracture. Voluntary and non-weight bearing knee joint motion to partially weight bearing was taken one week after operation. Progressive loading was taken continuously until there was clinical evidence of fracture stability and then full weight beating was done. Results The mean follow-up period was 15.9 months （ 10-24 months ）. All the fractures got united and the mean union time was 4.2 months（3-8 months）. All the injured knees could extend to less than 5 degrees and flex to more than 90 degrees after rehabilitation. Evaluated by Merchant score system for knee joint, 81% of patients achieved excellent healing （7 cases） and good healing （10 cases）. Conclusion Operation by using reinforced bar-ring hybrid external fixator combined with limited internal fixation can reduce complications and avoid stiffness of the knee joint. It is an effective method for complex fractures of tibial plateau.