双侧钢板内固定治疗高能量胫骨平台骨折

Double-plating for high-energy tibial plateau fractures

目的探讨双侧钢板内固定治疗高能量胫骨平台骨折的疗效。方法对25例胫骨平台骨折患者采用切开复位、胫骨平台内外侧分别使用钢板固定。结果术后伤口均一期愈合,患者均获随访,时间10～24个月,无感染、关节面塌陷、力线丢失等情况发生。术后X线片提示股胫角(FTA)平均177°±1.7°,胫骨平台内翻角(TPA)平均86°±2.1°,后倾角(PA)平均9°±3.1°。术后第3、6、12个月分别复查标准正、侧位X线片角度均无丢失。骨愈合时间平均16±3.5周,术后12～20周开始完全负重,随访期内无一例出现膝关节不稳。术后膝关节活动度伸直0°～5°,屈曲90°～130°。膝关节功能采用HSS评分,平均(90.5±6.5)分。结论采用双钢板联合内固定能为高能量胫骨平台骨折提供良好的力学稳定性,是一种理想的治疗方法。

Objective To evaluate the efficacy of double-plating for treatment of high-energy tibial plateau fractures. Methods 25 cases of high energy fractures of the tibial plateau were treated by double plates internal fixation. Resuits All got incision primary healing. All patients were followed up for 10 -24 months. There was no infections, no collapse in articular surface and no loss in alignment in all the cases. Postoperative imaging showed the mean FTA was 177° ± 1.7°, the mean TPA was 86° ± 2.1 ° and the mean PA was 9° ± 3.1 °. No significant changes of the above alignment parameters were found in 3,6 and 12 months after the operations. The mean time to full weight-bearing was 16 ± 3.5 weeks. At the final follow-up, no patients showed knee instability. Range of motion at the final fol- low-up was 0° - 5°, and flexion was 90° - 130°. The mean 1 year postoperative HSS was 90.5 - 6. 5. Conclusions The double-plating operation is an effective way of treating high-energy tibial plateau fractures, which provides reliable fragments stability.