内外侧接骨板加自体髂骨移植治疗SchatzkerⅣ-Ⅵ型复杂胫骨平台骨折

Bilateral bone plate with autogenous iliac bone graft in treating Schatzker Ⅳ-Ⅵ complex tibial plateau fractures

目的 :探讨双切口联合内外侧接骨板加自体髂骨移植治疗SchatzkeⅣ-Ⅵ型复杂胫骨平台骨折的临床疗效。方法:自2011年12月至2012年12月,采用内外侧接骨板加自体髂骨移植治疗SchatzkeⅣ-Ⅵ型复杂胫骨平台骨折患者32例,其中男20例,女12例;年龄19~54岁,平均37.4岁;左侧14例,右侧18例;受伤至手术时间5 h^9 d,平均3.5 d。按照Schatzker分型:Ⅳ型8例,Ⅴ型16例,Ⅵ型8例;Oestern闭合骨折分型:Ⅰ型5例,Ⅱ型19例,Ⅲ型7例,Ⅳ型1例。观察其术后并发症情况,并采用Lysholm评分进行术后功能评价。结果:术后32例获得随访,时间10~23个月,平均14个月。膝关节功能参照Lysholm评分进行评价,总分88.91±8.41;优20例,良9例,差3例。1例术后伤口感染胫骨外露,经换药及皮瓣转移后愈合。12~18个月取出内固定,无骨折不愈合。结论:双切口联合内外侧接骨板加自体髂骨移植治疗SchatzkeⅣ-Ⅵ型复杂胫骨平台骨折具有暴露清楚、固定牢靠、术中血运损伤较小以及愈合条件良好等优势,临床疗效满意。

Objective：To explore clinical curative effects of bilateral bone plate with autogenous iliac bone graft for the treatment of Schatzker Ⅳ-Ⅵ complex tibial plateau fractures. Methods：From December 2011 to December 2013,32 patients with complex tibial plateau fractures（Schatzker Ⅳ-Ⅵ） were operated by bilateral bone plate with autogenous iliac bone graft.Among them,including 20 males and 12 females with an average age of 37.4 years old ranged from 19 to 54 years old; 14 cases on the left side and 18 cases on the right side; the time from injury to operation ranged from 5 h to 9 d with an average of 3.5 d.According to Schatzker classification,8 cases were type Ⅳ,16 cases were type Ⅴ and 8 cases were type Ⅵ;according to Oestern closed fracture classification,5 cases were typeⅠ,19 cases were typeⅡ,7 cases were type Ⅲ and 1 case was type Ⅳ.Postoperative complications were observed and Lysholm scoring were used to evaluate functional assessment. Results：Thirty two patients were followed up from 10 to 23 months with an average of 14 months. According to Lysholm scoring,totall score was 88.91±8.41,20 cases got excellent results,9 moderate and 3 poor. One patient occurred postoperative wound infection and exposure of tibia,while healed after dressing changing and skin flap transplantation. All patients were removed internal fixation ranged from 12 to 18 months without fracture non union. Conclusion：Bilateral bone plate with autogenous iliac bone graft for the treatment of Schatzker Ⅳ-Ⅵ complex tibial plateau fractures has advantages of clear exposure,stable fixation,less trauma to the intraoperative blood supply and good fracture healing.