改良双钢板法与微创内固定系统治疗复杂胫骨平台骨折的对照研究

Modified dual plating versus less invasive stabilization system fixation for complex tibial plateau fractures:a clinical comparative study

目的比较改良双钢板法与微创内固定系统(LISS)治疗复杂胫骨平台骨折的疗效。方法回顾性分析2003年11月～2004年11月间应用改良双钢板法(48例)及LISS(36例)治疗的复杂胫骨平台骨折患者84例(SehatzkerⅤ型24例,SehatzkerⅥ型60例),比较两种治疗方法在手术时间、失血量、骨折愈合时间、完全负重时间、关节功能、相关并发症的发生率、胫骨平台内翻角(TPA)及后倾角(PA)变化等方面的差异。结果所有患者获得平均16．2个月(12～23个月)随访。改良双钢板组平均手术时间143min,术中失血量320mL,9例发生并发症,X线愈合时间平均为15．1周(11～23周),完全负重时间平均为16．8周(12～25周),术后1年膝关节美国特种外科医院(HSS)评分63～98分,平均87．4分。LISS治疗组平均手术时间127min,术中失血量290mL,6例发生并发症,X线愈合时间平均为13．8周(9～17周),完全负重时间平均为14．1周(11～18周)。术后1年膝关节HSS评分65～97分,平均89．6分。两组间上述内容比较差异均无显著性意义(P＞0．05)。两组患者术后即刻、3个月及1年的TPA和PA度数组间及组内比较,差异均无显著性意义(P＞0．05)。结论对于大部分的复杂胫骨平台骨折,单侧LISS固定可以起到与改良双钢板相似的治疗效果,但在一些特殊情况下,仍需要加用内侧辅助钢板固定。

Objective To compare the functional and radiographic outcomes of modified dual plating and less invasive stabilization system （LISS） in treatment of patients with complex tibial plateau fractures. Methods From November 2003 to November 2004, 84 patients with complex tibial plateau fracture were treated with modified dual plating or LISS fixation. Their functional and radiographic outcomes were reviewed to compare the differences in bone union time, full weight-bearing time, knee joint＇s HSS （The Hospital for Special Surgery）scores, complications, tibia plateau angle （TPA） and posterior slope angle （PA）. Results The 84 cases had complete follow-up records and a mean follow-up of 16. 2 months （range, 12 to 23 months）. Nine complications occurred in the modified dual plating group. The mean full weight-bearing time and radiographic bone union time were 16. 8 and 15. 1 weeks respectively for this group which had a mean HSS score of 87.4 points. Six complications were found in the LISS group. The mean full weight-bearing time and radiographic bone union time were 14. 1 and 13.8 weeks respectively for this group which had a mean HSS score of 89. 6 points. There were no significant differences between the two groups in changes of TPA and PA. Conclusion LISS can provide as good fixation as modified dual plating can for most complex tibial plateau fractures, but additional medial plate fixation may be necessary for some special cases.