三柱理论在胫骨平台粉碎性骨折治疗中的应用

Application of Three-column Theory in the Treatment of Complex Fractures of Tibiai Plateau

目的：探讨三柱理论在胫骨平台粉碎性骨折治疗中的临床应用和疗效分析方法回顾性分析本院2010年1月～2013年1月收治的胫骨平台粉碎性骨折患者42例，均为三柱骨折。所有患者均根据三柱理论采用合理的手术入路及内固定方式，平台塌陷处以同种异体骨植入，术后随访1年，X片观察骨折复位及愈合程度，比较HSS、Rasmussen评分并观察并发症的发生情况。结果所有患者术后当时均得到良好固定；膝关节内翻角和后倾角均得到纠正，Rasmussen放射学评分满意，术后与术前比较差异有统计学意义（P＜0.05）。膝关节功能恢复满意，术后1年HSS评分优良率达到90%。除了2例患者术后前外侧伤口裂开，经换药后愈合，未发生深部感染；无一例患者发生内固定松动及断裂。结论三柱固定理论在治疗粉碎性胫骨平台骨折中能起到有效的指导作用，安全性较高。

Objective To investigate the clinical effect of three-column fixation in the treatment of omminuted tibial plateau fracture under the guidance of three-column theory. Methods From January 2010 to January 2013, 42 cases in our hospital with comminuted fracture of tibial plateau were collected. All patients adopted three-column fixation, and tibial plateau depression treated with bone graft. After postoperative follow-up of 1 years, fracture reduction and healing were observed by X-ray, HSS score and Rasmussen score were compared. At the same time to observe the complications. Results The fixation was good, postoperative knee varusangle and dip angle were well corrected, Rasmussen score was satisfied, was significant difference between preoperative and postoperative （P ＆lt; 0.05）. Knee joint function was restored, by HSS score, the good to excellent rate of Knee joint function was 90%in postoperative 1 years. There were no obvious complications except 2 patients with traumatic arthritis. Conclusion Three-column fixation theory is conducive beneficial in clinical treatment of comminuted tibial plateau fracture, mainly in the medium-term follow-up. Three-column ifxation can make better fracture eduction and stable ifxation, high security.