外支架转内固定分期治疗高能量胫骨平台骨折的疗效分析

The Efficacy of External Fixation Change to Internal Fixation in Staged Management of High-energy Tibial Plateau Fractures

目的探讨应用外支架转换内固定分期治疗高能量胫骨平台骨折的疗效。方法自2010年5月到2014年1月收治21例高能量胫骨平台骨折患者,其中男18例,女3例,年龄17～60岁,平均43.8岁。采用分期治疗：初期采用单臂或组合外支架（Orthofix）超关节固定;待全身情况好转及局部软组织条件好转后,再一期或二期转换为接骨板内固定治疗。采用X线评估骨折愈合及Rasmussen膝关节功能评分系统评价术后膝关节功能恢复情况。结果 21例患者平均外支架固定时间为11.8 d（7～17 d）。均转为内固定,其中18例一期转换内固定治疗（85.7%）;2例因创面及1例钉道感染,行二期转换内固定（14.3%）。术后平均随访16.3个月（3～24个月）,所有切口均愈合,有1例（4.7%）局部皮肤坏死,2例（9.5%）浅表感染,经对症治疗后愈合;无深部感染、骨筋膜室综合征及骨髓炎等并发症。所有病例均获得骨性愈合,平均X线愈合时间6个月（3～10个月）。随访终末平均膝关节活动度99°（50°～130°）。Rasmussen膝关节功能评级,优10例,良8例,可3例,优良率85.7%。结论在高能量胫骨平台骨折的治疗中,采用外支架转换内固定的分期治疗策略,符合损伤控制原则,可有效降低软组织并发症,提高疗效。

Objective To study the clinical efficacy of external fixation change to internal fixation in staged management of high-energy tibial plateau fractures.Methods Twenty-one patients with high-energy tibial plateau fractures were managed from May 2010 to January 2014.Their average age was 43.8 years.All the patients were treated by temporary external fixator in the early stage.Then they were replaced by strong internal fixation through open reduction or close reduction when general conditions were controlled and the soft tissues improved in different time.Postoperative orthopaedic evaluation included X-rays and the Rasmussen＇s functional knee score.Results The mean duration of external fixation was 11.8 days.All the external fixations were changed to internal fixations,eighteen patients were directly replaced（ 85.7%）,and two patients were delayed replaced because of poor wound condition and one of pintract infection.After a mean follow up of 16.3 months,all the operative wounds finally healed,but one（ 4.7%） case occurred local skin necrosis,two cases（ 9.5%） endured superficial infections and healed after treatment.No deep infection,compartment syndrome or osteomyelitis occurred in this study.All bone fractures united.The average X-ray healing time was 6 months.The average range of motion of knee joint at final follow-up was 99°.The Rasmussen＇s functional knee score received an excellent-and-good rate of 85.7%.Conclusion In the management of highenergy tibia plateau fractures,the strategy of Staged Management,involving immediate temporary external fixation and delayed change to definitive internal fixation on right time,can effectively reduce soft tissue complications and improve the outcome.