双侧钢板与多轴锁定钢板内固定治疗复杂胫骨平台骨折

Internal fixation of bilateral plates versus polyaxial locking plates in the treatment of complex fractures of tibial plateau

目的探讨双侧钢板与多轴锁定钢板内固定治疗Ⅴ型、Ⅵ型复杂胫骨平台骨折的临床疗效。方法选择2013年1月至2014年12月东莞仁康医院收治的100例Ⅴ型、Ⅵ型复杂胫骨平台骨折患者,随机分为双钢板组和多轴钢板组(n=50),双钢板组采用双侧钢板内固定,多轴钢板组采用多轴锁定钢板内固定。观察两组手术时间、术中出血量、住院时间、骨折愈合时间和完全负重时间,评估术后6个月膝关节活动度和膝关节功能评分,记录术后并发症发生情况。结果多轴钢板组在手术时间、手术出血量、住院时间方面均少于双钢板组(P<0.05);两组术后6个月膝关节活动度比较,差异无统计学意义(P>0.05),但多轴钢板组Merchant膝关节功能评分优良率优于双钢板组,并发症发生率亦低于双钢板组,两组比较,差异有统计学意义(P<0.05)。结论对于Ⅴ型、Ⅵ型复杂胫骨平台骨折,双侧钢板与多轴锁定钢板内固定术后均能获得满意的膝关节活动度和关节功能;与双侧钢板比较,多轴锁定钢板内固定适用范围广、手术时间和住院时间短、出血量少、术后并发症发生率低、关节功能恢复理想,是治疗复杂胫骨平台骨折的较好选择。

Objective To study the clinical effects of internal fixation of bilateral plates versus polyaxial locking plates in the treatment of type Ⅴ, type Ⅵ complex fractures of tibial plateau. Methods A total of 100 patients with type Ⅴ, type Ⅵ complex fractures of tibial plateau treated from January 2013 to December 2014 in Renkang Hospital of Dongguan City, were divided into two groups randomly, patients in bilateral plate group underwent bilateral plates fixation, while patients in polyaxial plate group performed polyaxial locking plates fixation. Operation time, intraoperative estimate blood loss, hospital stay, fracture healing time and full weight-bearing time were observed, range of motion （ROM） and function scoring of knee joint were evaluated at 6 months postoperatively, at the same time, postoperative complications were recorded. Results Operation time intraoperative estimate blood loss and hospital stay in polyaxial plate group were lower than those in bilateral plate group （P 〈0.05）; At 6 months after the surgery, there was no statistical difference of ROM of knee joint between two groups （P 〉0.05）, while the excellent and good rate of Merchant function score of knee joint in polyaxial plate group were higher than that in bilateral plate group, also, incidence of postoperative complications in polyaxial plate group was lower than that in bilateral plate group, the difference between two groups had statistical significance （P 〈0.05）. Conclusions For type Ⅴ, type Ⅵ complex fractures of tibial plateau, bilateral plates and polyaxial locking plates fixation could achieve satisfactory ROM and function relief of knee joint; Polyaxial plates fixation is a good choice due to its broad applicable scope, short operation time and hospital stay, less blood loss, low incidence of postoperative complications and good rehabilitation of joint function when compared with bilateral plates fixation.