有限切开撬拨复位三柱固定治疗复杂胫骨平台骨折

Three-column internal fixation for the treatment of complex tibial plateau fractures by limited exposure and poking reduction

[目的]探讨有限切开撬拨复位三柱固定治疗复杂胫骨平台骨折的临床效果。[方法]自2011年9月～2014年2月,在C型臂X线透视机监视下采用联合入路有限切开、撬拨复位、三柱内固定治疗复杂胫骨平台骨折25例。根据Schatzker分型：Ⅴ型19例,Ⅵ型6例,CT扫描均为三柱骨折;骨折复位满意后三柱坚强内固定防止关节面塌陷,术中自体髂骨植骨7例。[结果]25例均获得随访,随访时间13～28个月,平均16.5个月。骨折愈合时间平均为4.5个月,未见平台高度丢失。膝关节功能按HSS评分标准,优20例,良2例,可3例,优良率为88.0%。术后即刻胫骨平台内翻角（TPA）、胫骨平台后倾角（PA）和股胫角（FTA）与术后1年比较差异均无统计学意义（P〉0.05）。[结论]有限切开撬拨复位三柱固定治疗累及三柱的复杂胫骨平台骨折软组织损伤小,内固定坚强,可早期功能锻炼,关节功能恢复好,并发症少。

[ Objective] To investigate the clinical results of three-column internal fixation in the treatment of complex tibial plateau fractures by limited exposure and poking reduction. [ Method ] From September 2011 to February 2014, 25 cases of complex tibial fractures were treated using three-column reconstruction technique with limited exposure and poking reduction un- der fluoroscopic control. According to Schatzker classification, there were 19 cases of type V and 6 cases of type VI, which were all three-column fractures of tibial plateau based on CT scan . Meanwhile, rigid internal fixation was achieved by three-column reconstruction after satisfactory joint surface reduction and autogenous iliac bone was selected for bone grafting in 7 cases during the surgery. [ Result] Twenty-five patients were followed up for 13 to 28 months, with an average of 16.5 months. The fractures all healed in 4.5 months and no height loss was found. According to the HSS score system,20 tibiae were rated as excellent, 2 as good and 3, as fair,the rate of excellent and good outcomes was 88.0%. There were no significant differences between imme- diate postoperation and one year postoperation on the tibial plateau angle （ TPA）, posterior slope angle （PA） and femorotibial an- gle （FTA）（ P 〉 0.05 ）. [ Conclusion] In treatment of complex tibial plateau fractures involving three-column, limited exposure and three-column reconstruction after poking reduction have advantages of minimal trauma, stable fixation, early movement,bet- ter joint function and fewer complications.