三柱固定治疗累及后柱的老年胫骨平台双髁骨折

Three- column fixation for bicondylar posterior column fractures of elderly patients

[目的]探讨三柱理论指导多钢板固定治疗累及后柱老年胫骨平台双髁骨折的临床效果。[方法]2010年1月-2012年2月采用联合入路多钢板内固定治疗累及后柱的老年胫骨平台骨折患者23例。根据Schatzker分型,Ⅴ型14例,Ⅵ型9例。术中坚强内固定防止关节面塌陷。[结果]本组23例均获得随访,平均随访30.7个月,膝关节HSS评分优良率为86.9%。术后即刻与术后2年胫骨平台内翻角（TPA）及后倾角（PA）比较,差异无统计学意义（P〉0.05）,术后1例发生前外侧切口愈合欠佳,术后无神经症状,无内固定失效松动断裂。[结论]多钢板治疗老年胫骨平台双髁骨折是有效的方法,术后早期功能锻炼,将明显提高疗效,减少并发症。

[Objective]This study was to evaluate the clinical outcomes following three- column theory for treating severe bicondylar posterior column fractures of elderly patients. [Method]Between Jannuary 2010 and February 2012,23 patients with severe bicondylartibial plateau fractures,were treated using multi- plate technique through combined approaches. According to Schatzker classification,9 cases were type Ⅵ 14 cases were type Ⅴ. Meanwhile,rigid internal fixation during operation could effectively support reduction of articular surface. [Result]All patients were followed up for an average of 30. 7 months. According to HSS score standard,the excellent and good results rate was 86. 9%. There was no significant difference of TPA and PA between postoperation immediately and postoperation two years later. Postoperative complications included superficial dehiscence in one case in the anterolateral incision. There was no neurovascular damage,and no implant breakage or loosening. [Conclusion]Multi- plate reconstruction is a valid and safe method for treating severe bicondylartibial plateau fractures of elderly patients. It will improve the effect and reduce complications significantly to help the early functional exercises postoperatively.