复杂胫骨平台骨折手术时机与手术方式选择及疗效分析

Surgical timing, preferable procedure options and corresponding efficacy analysis for complicated tibial plateau fractures

目的探讨复杂胫骨平台骨折最佳手术时机与手术方式的选择。方法105例SehatzkerV、VI型胫骨平台骨折急诊或择期分别采用膝前外侧单切口单钢板内固定（A组，26例）、膝内外侧双切1：1双钢板内固定（B组，27例）、膝前正中直切口双钢板内固定（C组，30例）、膝前后联合人路单或双钢板内固定（D组，6例）、小切口或闭合复位外固定架固定（E组，16例）。结果术后均获随访26—1lO个月，平均36．5个月；闭合性骨折不同手术时机切口并发症发生率：58．3％、45．5％、13．3％、2．4％、33-3％。5组术中平均出血量：（265．7±125．0）、（373．7±137．3）、（308．4±120．5）、（461．7＋90．4）、（95．6±31．6）ml；内固定失效率：23．1％、3．7％、3．3％、0％、25％；膝关节功能优良率：76．9％、85．1％、93．3％、100％、68．8％。结论手术时机在伤后6．8d局部软组织肿胀消退、皮肤皱纹出现时最佳，切口并发症最少；多种手术入路与手术方式的灵活、合理应用，有利于高效治疗复杂胫骨平台骨折。

Objective To investigate the optimal timing and preferable procedure options for complicated tibial plateau fractures （Schatzker classificationV and VI）. Methods A total of 105 patients with Schatzker classification V and VI tibial plateau fractures were included in this series. They were subject to an emergent or elective surgical intervention with procedures including： one plating via anterolateral incision （group A, 26 cases）;dual plating via anterolateral and posteromedial incisions （group B, 27 cases）; dual plating via single midline incision （group C, 30 cases）; dual plating via combined anterior and posterior approaches （group D, 6 cases）; ybrid external fixation via close reduction/ a minimal incision （group E, 16 cases）. Results A postoperative follow-up of 26-110 months （mean： 36.5 months） was performed. For the possible relationship between surgical timing and incidence of wound-associated complications, this incidence was 58.3%, 45.5%, 13.3%, 2.4% and 33.3%. The intraoporative mean blood loss was： （265.7±125.0）ml, （373.7±137.3）ml, （308.4±120.5）ml, （461.7±90.4）ml and （95.6±31.6）ml. The failure rate of f＇Lxation was 23.1%, 3.7%, 3.3%, 0% and 25%. The acceptable function rate of the five procedures was 76.9%, 85.1%, 93.3%, 100% and 68.8% respectively. Conclusion The optimized surgical timing at 6-8 days after traumatic injury as a result of subsided soft tissue swelling and optimally emerged skin wrinkles may minimize the surgical wound complications. Flexible and reasonable application of multiple procedures may contribute to the effective treatment of a complicated tibial plateau fracture.