多轴锁定钢板治疗复杂胫骨平台骨折的初步疗效分析

Multiaxial locking plates for treatment of complex tibial plateau fractures

目的 报告多轴锁定钢板治疗复杂胫骨平台骨折的方法及初步疗效。方法 2006年7月至2007年6月，采用开放复位、多轴锁定钢板内固定治疗复杂胫骨平台骨折25例，闭合性骨折21例，开放性骨折4例；骨折按Schatzker分型：Ⅳ型6例，Ⅴ型16例，Ⅵ型3例；根据影像学测量结果及HSS评分标准进行临床效果评定。结果 所有患者术后获得7～15个月（平均10．5个月）随访，骨折4～6个月后骨折均获骨性愈合，术后6个月膝关节HSS评分78～96分，平均88．4分。发生皮瓣坏死1例，切口局部感染1例，无一例发生内固定松动、断裂或骨折复位丢失现象。术后1周、3个月及6个月的内翻角和后倾角比较差异无统计学意义（P〉0．05）。结论 胫骨平台多轴锁定钢板操作简便，锁定螺钉置入角度选择性高，内固定稳定性好，避免了原始及继发复位的丢失，是手术治疗复杂胫骨平台骨折安全、有效的内固定方法。

Objective To report clinical effects of multiaxial locking plates in the treatment of the complex tibial plateau fractures. Methods From July 2006 to June 2007, 25 cases of complex tibial plateau fractures, 18 males and 7 females, were treated with surgical reduction and internal fixation using muhiaxial locking plates. The mean age of the patients was 32.8（20 to 56） years. There were 21 closed fractures and 4 open ones. According to Schatzker classification, 6 cases were of type IV, 16 of type V, and 3 of type V[. The follow-up period lasted 10. 5（7 to 15） months on average. The knee functions in all the patients were assessed according to radiologieal manifestations and HSS scoring. Results All fractures united at 4 to 6 months postoperatively and the average HSS score after half a year was 88.4 （78 to 96）. Skin flap necrosis was found in 1 case and incision infection in another. No loosening or rupture of the fixator, or reduction failure was observed. Conclusions The multiaxial locking plate is an effective fixator for complex tibial plateau fractures due to its convenience and stability. The locking screws can be implanted in various directions and the primary and secondary reduction failures can be avoided.