内固定与外支架固定治疗复杂性胫骨平台骨折的对比研究

COMPARATIVE STUDY ON INTERNAL FIXATION AND EXTERNAL FIXATION FOR THE TREATMENT OF COMPLEX TIBIAL PLATEAU FRACTURE

目的比较单纯内固定与有限内固定加外固定支架治疗复杂性胫骨平台骨折的效果及优缺点。方法2002年7月-2006年8月,收治复杂性胫骨平台骨折66例,分成内固定组和外固定支架组。内固定组39例,其中男25例,女14例;年龄18～79岁,平均45.4岁。按照Schatzker分型,Ⅳ型18例,Ⅴ型7例,Ⅵ型14例。外支架固定组27例,其中男18例,女9例;年龄18～64岁,平均44.2岁。按照Schatzker分型,Ⅳ型13例,Ⅴ型6例,Ⅵ型8例。两组一般资料比较差异均无统计学意义(P>0.05)。按照内固定原则分别采用螺钉、钢板或外固定支架固定进行治疗。结果患者均获随访,随访时间1～5年,骨折均达临床愈合,无骨不连发生。内固定组2例出现局部皮肤感染、坏死,经换药、皮瓣移位后治愈;骨折愈合时间6～14个月,平均7.3个月;内固定取出时间6～15个月,平均8.3个月。外固定支架组11例于术后7d～3个月出现针道流液,局部皮肤发红,3例出现皮肤坏死,3例在随访中发现螺栓松动,经清创、换药、植皮等处理创面愈合;骨折愈合时间为3～11个月,平均5.1个月;拆除外支架时间为5～11个月,平均6.4个月。术后8～14个月,参照Merchant等标准评定膝关节功能,内固定组优29例,良4例,中5例,差1例;外固定支架组优20例,良3例,中2例,差2例;两组膝关节功能比较差异无统计学意义(P>0.05)。结论单纯内固定与有限内固定加外固定支架治疗复杂性胫骨平台骨折的效果相当,对于SchatzkerⅣ、Ⅴ、Ⅵ型胫骨平台骨折,应根据患者受伤情况、骨质条件选择固定材料。

Objective To compare effects, advantages and disadvantages of simple internal fixation to that of limited internal fixation with external supporting frame fixation in the treatment of complex fractures of tibial plateau. Methods From July 2002 to August 2006, 66 cases of complex fractures of the tibial plateau were divided into the internal fixation group （n=39） and the external fixator group （n=27）. The interal fixation group had 18 cases of IV, 7 cases V and 14 cases VI according to Schatzker, including 25 males and 14 females aged 18-79 years with an average of 45.4 years. The exteMal fixator group had 13 cases of IV, 6 cases V and 8 cases VI according to Schatzker, including 18 males and 9 femles aged 18-64 years with an average of 44.2 years. No significant difference was evident between the two groups （P 〉 0.05）. Patients were treated by using screws, steel plates or external supporting frame fixation strictly based on the principle of internal fixation. Results All patients were followed up for 1-5 years. Fracture healed with no occurrence of nonunion. Two cases in the internal fixation group presented partial skin infection and necrosis, and were cured through the dressing change and flap displacement. Fracture healing time was 6-14 months with an average of 7.3 months. The time of internal fixator removal was 6-15 months with an average of 8.3 months. In the external fixation group, 11 cases had nail treated fluid 7 days to 3 months after operation, combining with red local skin; 3 cases had skin necrosis; and 3 cases had loose bolts during follow-up. Through debridement, dressing change and flap displacement, the skin wounds healed. Fracture healing time was 3-11 months with an average of 5.1 months. The time of external fixator removal was 5-11 months with an average of 6.4 months. At 8-14 months after operation, the knee function was assessed according to Merchant criteria. In the internal fixation group, 29 cases were excellent, 4 good, 5 fair and 1 poor, while in the external fixation group, 20 cases were excellent, 3 good, 2 fair and 2 poor. There was no significant difference between the two groups （P 〉 0.05）. Conclusion The therapeutic effects of simple internal fixation and limited internal fixation with external supporting frame fixation were similar in the treatment of complex fracturesof tibial plateau. Fixation materials should be selected according to the state of injury and bone conditions for the treatment of tibial plateau fracture of type IV, V and VI based on Sehatzker classification.