联合后方拉力螺钉治疗累及后柱的复杂胫骨平台骨折

Application of posterior screws fixation in the treatment of fractures of the central tibial plateau

目的评价联合后方拉力螺钉对合并胫骨平台后柱骨折的固定效果。方法选择徐州医科大学附属医院骨科收治的胫骨平台骨折患者43例，随机分为观察组和对照组。观察组采用联合后方拉力螺钉固定后柱骨折，对照组采用单纯内侧或外侧钢板固定，记录2组内固定手术时间、内固定过程中出血量、骨折愈合时间、完全负重时间。观察伤口愈合情况及有无并发症发生。美国特种外科医院膝关节功能评分系统（the hospital for special surgery，HSS）评分评定膝关节功能。结果2组资料在年龄、性别等一般情况上具有可比性，联合后方拉力螺钉组手术时间更长、术中出血量更多。2组在骨折愈合时间和完全负重时间上无显著差异（P〉0．05）；在膝关节功能HSS评分上：观察组为（81±5）分，对照组为（77±6）分，2组差异有统计学意义（P〈0．05）。结论对累及后柱的胫骨平台骨折采用后方拉力螺钉固定可靠，对于胫骨平台骨折，应根据患者受伤情况、骨折的分型、后柱骨折的累及情况等选择固定方式。

Objective To evaluate the therapeutic effects of posterior screws fixation on the fractures of the central tibial plateau. Methods A total of 43 patients were included into the current study, who were admitted into our hospital due to tibial plateau fractures. The patients were randomly divided into an observation group and a control group. In the observation group, the fractures of the central plateau were fixed using posterior screws in additional to intern fixation. In contrast, medial or lateral plate fixation was adopted in the control group. Then, both groups were compared for the time of internal fixation, blood loss during surgery, fracture healing time, and complete loading time. Meanwhile, wound healing and complications were also observed. The hospital for special surgery （HSS） knee score was used to evaluate knee joint function. Results No significant difference was found between the two groups in age, gender and other general information. Fixation of posterior screws required longer surgical time and caused more blood loss during operation. There were no significant difference in fracture healing time and complete loading time between the two groups （ P 〉 0. 05 ）. The knee function score was （81 ±5 ） for the observation group and （77 ±6） for the control group, which were statistically different （P 〈0. 05）. Conclusions The use of posterior screws is helpful in fixation of the fractures of the central tibial plateau. Meanwhile, an appropriate internal manner should be selected according to patient condition, fracture type and clinical conditions.