解剖锁定钢板治疗胫骨平台骨折24例临床分析

Clinical analysis of 24 cases of fracture of anatomical plate in the treatment of tibial locking

目的探讨解剖锁定钢板内固定治疗胫骨平台骨折的疗效。方法 2010年1月—2013年6月,对24例胫骨平台骨折患者采取髌旁前外侧切口、前内侧切口、前外侧切口加后内侧小切口或髌正中纵行切口,单纯胫骨近端外侧解剖锁定钢板或加内、后侧＂T＂形锁定、重建钢板复位内固定。结果本组24例均获得随访,时间6个月-30个月,平均15个月。术后6个月-12个月骨折全部愈合,内固定无松动断裂,其中1例切口浅表感染,培养表皮葡萄球菌感染,经负压封闭引流术（VSD）负压吸引1周,抗感染、植皮4周痊愈。1例腓总神经损伤,足背伸无力。采用Rasmussen功能评定标准：优14例,良7例,可2例,差1例,优良率87.5%。结论不同类型的胫骨平台骨折,选择不同入路、解剖锁定钢板内固定治疗,早期功能锻炼,是一种有效的方法。

Objective To investigate the choice of different approach, anatomic locking plate fixation in thetreatment of different types of tibial plateau fractures.Methods from 2010-01-2013-06, 24 cases of tibial plateau fracture by patellar, anterior lateral incision, anterior medial incision, anterior lateral incision combined with small incision or patellar medial posterior median longitudinal incision. Simple proximal lateral tibiaanatomical locking plate , or with＂T＂type, rear locking reconstruction plate internal fixation.Results in this group, 24 cases got follow-up, 6 months to 30 months, average 15 months. After 6 to 12 months, all fractures healed, no loosening of the internal fixation of fracture,one case of superficial infection, Staphylococcus epidermidis infection by VSD culture, negative pressure suction a week, anti infection, skin grafting for 4 weeks.A case of sural total nerve damage, weak foot dorsiflexed. Using the Rasmussen function evaluation：excellent in 14 cases, good in 7 cases, 2 cases, poor in 1 cases. Excellent rate was 87.5%.Conclusion Choose a different approach,anatomic locking plate fixation in the treatment of different types of tibial plateau fractures, early functional exercise, is an effective method.