双侧固定治疗复杂胫骨平台骨折

Bilateral fixation for complex tibial plateau fractures

目的 探讨双侧固定治疗复杂胫骨平台骨折的疗效. 方法 选取2003年7月至2006年10月采用胫骨平台双侧固定方法治疗的43例复杂胫骨平台骨折患者,骨折按Schatzker分型：Ⅴ型26例,Ⅵ型17例.一期胫骨近端双侧钢板螺钉固定28例,单侧钢板螺钉内固定结合对侧克氏针＋外固定支架固定9例.伤后急诊外固定支架临时固定,软组织条件改善后二期改用钢板螺钉固定2例;克氏针内固定＋跨膝关节外固定支架固定4例. 结果 43例患者术后获12～28个月（平均18.4个月）随访.除5例感染患者外,其余38例患者骨折愈合时间平均为4.5个月,完全负重时间平均为5.5个月.术后1年时膝关节活动度平均为95°;根据膝关节HSS评分评定疗效：优29例,良8例,中6例,优良率为86.0%.术后即刻胫骨平台内翻角、胫骨平台后倾角及股胫角与术后1年比较差异均无统计学意义（P〉0.05）. 结论 复杂胫骨平台骨折固定方式的选择应根据软组织条件的不同而灵活掌握,但应遵循双侧固定的同时尽早解放膝关节的原则,术前对软组织损伤恢复程度的正确评估直接影响治疗的最终效果.

Objective To evaluate clinical efficacy of the bilateral fixation used for the complex tibial plateau fractures. Methods From July 2003 to October 2006, 43 patients with complex tibial plateau fracture were treated with bilateral fixation. According to the Schatzker classification, 26 cases were of type Ⅴ and 17 of type Ⅵ. Bilateral incisions and dual plating at one stage were adopted in 28 patients. Nine patients were fixed by plating at one side and Kirschner wire plus external fixation at the other. Two patients were fixed with external fixation initially, but with bilateral incisions and dual plating at the second stage after soft tissue recovery. Four patients were treated with external fixation and Kirschner wire. Results All patients were followed up for a mean duration of 18.4 months （range, 12 to 28 months） . Bone union was observed in all cases after an average of 4. 5 months. The mean time for full weight bearing was 5.5 months.The mean knee territory was 95°. According to HSS scoring, the knee functions were excellent （〉 85） in 29cases, good （70 to 84） in 8 cases, and fair （60 to 69） in 6 cases, with a good to excellent rate of 86. 0%. There were no significant differences between immediate postoperation and one year postoperation in the tibial plateau angle （TPA）, posterior slope angle （PA） and femorotibial angle （FTA） （ P〉0.05 ）. Conclusion Although complex tibial plateau fracture should be treated basically with bilateral fixation, it should be used flexibly according to the condition of the soft tissue, because correct judgment of the condition of the soft tissue can directly influence the final efficacy of the treatment.