双切口3块钢板置入内固定治疗合并复杂后侧骨折的胫骨平台三柱骨折

Three-plate fixation through two incisions for three-column fractures of tibial plateau with complex posterior fractures

背景:胫骨平台3柱骨折多为高能量暴力引起,一般为粉碎性骨折,伴随关节面破裂、塌陷,合并严重软组织损伤,并发症多,是创伤骨科的难点。目的:观察前后联合双切口3块钢板固定治疗合并复杂后侧骨折的胫骨平台3柱骨折的临床效果。方法:采用前外侧联合后内侧双切口3块钢板固定治疗12例复杂胫骨平台3柱患者,前外侧切口采用一块高尔夫棒型钢板固定,后内侧用一块长钢板加一块短"T"型钢板固定。结果与结论:12例患者内固定后均获得12个月以上随访,骨折均获愈合。X射线愈合时间为(14.0±1.1)周,完全负重时间为(15.1±1.7)周。内固定后即刻Rasmussen评分为(16.8±0.6)分。内固定后12个月膝关节活动度屈126.3°,伸-1.3°,膝关节HSS评分为(89.1±2.5)分。内固定后即刻,3,12个月胫骨平台内翻角及胫骨平台后倾角度数比较,差异无显著性意义(均P>0.05)。患者内固定均未发生切口皮肤坏死、感染、内固定松动及断裂。结果表明,对于合并复杂后侧骨折的胫骨平台3柱骨折,双切口3钢板固定方法兼顾到了骨折的复杂性和胫骨平台后侧的解剖学形态特殊性,疗效确切可靠。

BACKGROUND： Three-column fractures of tibial plateau are always caused by high energy violence. The fractures are usually comminuted fracture with the articuar surface breaking and collapsing, and have severe soft tissues injury and many complications which are difficult points of orthopaedic trauma. OBJECTIVE： To describe the operative procedures and clinical outcomes of internal fixation with three-plate fixation through two incisions in treating three columns fractures of tibial plateau with complex posterior fractures. METHODS： Twelve patients with complex three columns fractures of tibial plateau were treated with two incisions three-plate fixation through the anterolateral approach combined with postero-medial approach. One ＂Golf＂ shape plate was used through anterolateral approach, and one long plate and one short ＂T＂ shape plate were used through postero-medial approach. RESULTS AND CONCLUSION： All patients were followed-up for more than 12 months. All fractures were cured. The mean radiographic bony union time was （14.0±1.1） weeks and the mean full weight-bearing time was （15.1±1.7） weeks. The Rasmussen score of all the patients immediately after operation was （16. 8±0.6）. The average range of motion of the affected knee joints at 12 month postoperatively were 126.3° flexion to -1.3° extension. The Hospital for Special Surgery score of all the patients at 12 months postoperatively was （89.1±2.5）. There were no significant differences in changes of the tibial plateau varus angle between the group immediately after operation, the group at 3 months postoperatively and the group at 12 months postoperatively and posterior slope angle （P 0.05）. No complication occurred such as necrosis of the incision, deep infection, the loosening and breakage of the internal fixation. The internal fixation with three plates through two incisions gives consideration to the complexity of fractures and the speciality of the posterior anatomy in tibial plateau, and is an effective and safe treatment for three columns fractures of tibial plateau with complex posterior fractures.