单钢板治疗胫骨平台双髁骨折并发症报告

Complications Associated with Internal Fixation of Bicondylar Tibial Plateau Fractures Treated with Isolated Lateral Plate

目的报告单块外侧支撑钢板治疗胫骨平台双髁骨折的相关并发症、感染率及功能评估。方法回顾自1996年3月～2003年7月收治的78例胫骨平台双髁骨折(男性50例,女性28例;年龄24～69岁,平均41岁),并进行功能评估和手术并发症统计分析,以P<0.05为显著性差异。结果Rasmussen功能评定优良率为74.4%。7例发生深部感染,深部感染的发生与关节功能不佳密切相关(P<0.05)。患者的年龄、性别、是否为开放性骨折、是否为延期或急诊手术、手术历时、术中出血量均未显现出与深部感染发生的相关联性,而植入异体骨成为本组资料中唯一与深部感染发生相关联的指标(P<0.05)。结论单块外侧支撑钢板治疗胫骨平台双髁骨折有较低的深部感染率,而异体骨植入可能增加深部感染的发生。正确的软组织条件判断和处理有助于降低切口相关并发症。

Objective To report the complications, the infection rate and the reduction associated with plating of complex AO type 41 - C tibial plateau fractures treated with the isolated lateral plate. Methods From 1996 to 2003, 78 patients （50 males, 28 females, age range 24 to 69 years old, mean age 41 years） suffered from bicondylar tibial plateau fracture were reviewed. Rasmussen＇s functional assessment and the complications associated with surgical procedures were analyzed statistically, with P 〈 0.05 indicating the significant difference. Results According to Rasmussen＇s system, the excellent and good rate was 74.4 %. Deep wound infections occurred in 7 patients and were considered as major complications. There was significant correlation between deep infection and poor clinical outcome （P〈0.05）. The patient gender, age, presence of open wounds, the time delay to definitive surgery, the operated duration and the amount of blood loss were not found to be statistically associated with the development of deep infection. The presence of allogenous bone graft was, however, associated with the development of deep infection. Conclusion The bicondylar tibial plateau fractures can be successfully treated with lower deep infections rate utilizing isolated lateral plate. Allogenous bone graft is at increased risk for deep sepsis and proper soft - tissue handling may contribute to a lower wound complication rate.