三钢板固定治疗复杂胫骨平台双髁四象限骨折的疗效分析

Complicated bicondylar four-quadrant tibial plateau fractures: early experiences using three plates internal fixation

[目的]探讨通过联合入路用三钢板治疗复杂胫骨平台双髁四象限骨折的疗效。[方法]选取2010年1月~2013年2月本院收治的复杂胫骨平台双髁四象限骨折患者28例。根据Schatzker分型均为Ⅵ型,AO/OTA分型为41C2、C3型。男23例,女5例,年龄21~63岁,平均42.6岁。摆仰卧漂浮体位用三块钢板坚强固定,以“钉-筏”形式支撑关节面防止二次塌陷,取自体髂骨或人工骨填充植骨,术后应用影像学及Rasmussen膝关节量表进行功能评价。[结果]28例均获得随访,随访时间24~36个月,平均28.5个月。术后骨折均临床愈合,断端无移位,内固定物无松动、断裂、失效等并发症发生,无关节面塌陷,关节功能基本恢复正常。术后膝关节Rasmussen量表评价,优19例,良6例,可2例,差1例,优良率为89.3%。术后即刻胫骨平台内翻角（TPA）及胫骨平台后倾角（PA）度数与术后1年比较,组间差异无统计学意义（P〉0.05）。[结论]应用三钢板内固定治疗累及双髁四象限的复杂胫骨平台骨折,具备能解剖复位、牢靠固定及早期膝关节功能锻炼等优点,是一种有效、安全的方法。

[ Objective]To explore the clinical efficacy of three plates fixation in the treatment of bicondylar tibial plateau fractures involving four - quadrants through combined multiple approaches. [ Method ] A total of 28 patients （23 male, 5 female） with bicondylar four - quadrant tibial plateau fractures were treated with three plates in our hospital from January 2010 to Febru- ary 2013. The age of patients were from 21 to 63 years （ mean, 42.6）. The patient was placed in a floating supine position. Through multiple incisions approaches, three anatomic locking plates were placed to fix the bone fragment, the articular facet was supported by a ＂raft -buttress＂ formation to avoid second collapse. Autogenous or artificial bone implant was given to fill the defect. Postoperative effects were observed according to imaging and Rasmussen joint functional grading system. [ Result] All pa- tients were followed up for 24 to 36 months, with an average of 28.5 months. All the fractures healed, no implant loosening, pulled - out or broken was found. The articular surfaces did not collapse, and joint function completely recovered. According to the Rasmussen knee joint function scoring system,, 19 cases were graded as excellent,6 cases as good,2 as fair and 1 as poor. The rate of excellent and good outcome was 89.3%. The tibial plateau varus angle（TPA） and posterior slope angle（PA） showed no significant difference between immediate postoperative and one year after operation （ P 〉 0.05 ）. [ Conclusion ] Three plates internal fixation is a valid and safe method for treating complicated bicondylar four - quadrant tibial plateau fractures, which is effective to achieve anatomic reduction, rigid internal fixation and early functional exercises.