双锁定钢板交叉支撑固定治疗累及后外侧的C3型胫骨平台骨折

Dual locking plate fixation for Type C3 tibial plateau fractures involving the posterior column

目的 探讨应用前外侧结合前内侧入路、双锁定钢板交叉支撑固定治疗伴有后外侧劈裂塌陷的C3型胫骨平台骨折的可行性、手术方法及近期疗效.方法 回顾性分析2011年3月至2012年12月,采用前外侧结合前内侧入路、双锁定钢板交叉支撑固定治疗15例累及后外侧的C3型胫骨平台骨折的患者资料,男9例,女6例;年龄27～56岁,平均42.6岁;均为闭合性骨折.术后进行临床及影像学检查,对术后X线片采用Rasmussen放射学评分进行评估,在术后第12个月随访时采用美国特种外科医院（hospital for special surgery,HSS）评分对膝关节功能进行评估.结果 15例患者均获得随访,随访时间12～23个月,平均13.5个月;手术时间120～210 min,平均196 min.术后完全负重时间8～20周,平均11.6周;骨折临床愈合时间12～16周,平均13.8周.术后即刻、3个月、6个月、12个月在X线片上测量的患肢胫骨平台内翻角及后倾角度数比较,差异均无统计学意义.膝关节功能HSS评分为85～95分,平均89.5分,均为优;术后Rasmussen放射学评分为14～18分,平均16.2分.1例患者术后2周出现内侧切口约4 cm的皮肤坏死,经清创负压引流后愈合.末次随访无一例发生感染、骨折不愈合、复位高度丢失、内固定松动、膝关节不稳及医原性神经、血管损伤等并发症.结论 采用前外侧结合前内侧入路、双锁定钢板交叉支撑固定治疗伴有后外侧劈裂塌陷的C3型胫骨平台骨折方法可行,该方法术中暴露充分,能够允许膝关节进行早期功能锻炼;术后近期疗效满意,未见明显角度丢失及关节面的再次塌陷,膝关节功能恢复好,未出现血管神经损伤、感染等严重并发症.

Objective To investigate and evaluate the effects of treating type C3 tibial plateau fractures involving the posterior column by dual locking plate fixation via modified anterolateral and anteromedial approach.Methods We retrospectively studied 15 patients with type C3 tibial plateau fractures involving the posterior column that were treated in our hospital from March 2011 to December 2012.The group included 9 males and 6 females,aged from 27 to 56 years old （average 42.6 years old）.All of the cases were closed fracture.During the treatment and follow-up period,the curative effect was evaluated by using Rasmussen＇s radiological grading for radiological outcomes at each follow-up and HSS grading for clinical examination about the knee joint function at the 12th follow-up.Results All patients obtained follow-up and the average follow-up time was 13.5 months （range,12-23 months）.The average time for the whole operation,full weight bearing and fracture union were 196 min （range,120-210 min）,11.6 weeks （range,8-20 weeks） and 13.8 weeks （range,12-16 weeks） respectively.No statistical difference was found in either the tibial plateau angle （TPA） or posterior slope angle （PA） when comparing the measuring results at instant,3rd month,6th month and 12th month on radiographies.All the results according to HSS grading are excellent and the mean score of the HSS grading was 89.5 （from 85 to 95）; the mean score of the Rasmussen＇s radiological grading was 16.2 （range,14-18）.Skin necrosis （about 4 cm） occurred at medial incision in one case at 2 week postoperatively.The patient was healed by debridement and negative pressure drainage.No complication,including infection,nonunion,reduction lost,fixation loosening,keen joint instability,iatrogenic injuries,occurred.Conclusion Treatment for type C3 tibial plateau fractures involving the posterior column by dual locking plate fixation via modified anterolateral and anteromedial approach is a feasible and effective method.Sufficient exposure,good reduction and fixation,earlier functional exercise can be achieved without several complications such as vascular and nerve injury and infection.The knee function recovered well and earlier curative effect was satisfied without noticeable TPA,PA loss and articular surface collapse during follow-up.