三钢板内固定治疗胫骨结节近端三柱骨折疗效分析

Analysis of three steel plate fixation in the treatment of proximal tibial tubercle three column fracture

目的基于三柱分型,探讨后内侧及外侧联合入路三钢板内固定治疗骨折线未涉及胫骨结节平面远端的复杂胫骨平台骨折的临床疗效。方法选取2012年10月至2015年4月间,基于三维CT及X-ray显示骨折线未涉及胫骨结节平面远端的复杂胫骨平台骨折患者共17例,特别强调内侧髁骨折线不超过胫骨结节平面。骨折按Schatzker分型：Ⅴ型13例,Ⅵ型4例。均采用基于三柱分型的内外侧联合入路三钢板内固定,一期行手术治疗。结果 17例患者术后获12~18个月（平均13.8个月）随访。患者的骨折愈合时间平均为4.4个月,完全负重时间平均为5.5个月。术后即刻摄片显示内侧髁后倾角恢复良好,术后6个月负重后,后倾角无明显丢失,也未见内侧髁出现台阶。术后1年时膝关节活动度平均为105°。根据膝关节HSS评分评定疗效：优（〉85分）10例,良（70~84分）4例,中（60~69分）3例,优良率为82.4%。无一例切口坏死、深部感染,无内固定松动等并发症。结论对于骨折线未涉及胫骨结节平面远端的SchatzkerⅤ型和SchatzkerⅥ型复杂胫骨平台骨折,特别是合并有内侧髁冠状位骨折的患者,因内侧骨折块较小,以双切口、三钢板内固定治疗,复位更容易,固定更可靠,而且对膝关节周围的软组织损伤小,并发症少,关节功能恢复快,是临床上值得推荐的治疗方法之一。

Objective To analyze the clinical effect of the treatment of tibial plateau fractures,based on three type column,combining multiple approaches of medial and lateral joint into the road after the paper plate internal fixation for fracture line not covered the complex and far side of tibial tubercle planar. Methods Selected17 patients with complex tibial plateau fractures without fracture line in distal tibial tubercle plane through threedimensional CT and X-ray from October 2012 to April 2015. At the same time,the medial condyle fracture line did not exceed the tibial tubercle plane. Fracture by Schatzker type points： 13 cases of V,Ⅵ type 4 cases. Adopt based on three pillars inside and outside the joint into the road of three steel plate internal fixation,issue of surgical treatment. Results All 17 cases of patients with postoperative get a follow-up visit every 12 ~ 18 months（ mean 13.8 months）. Healing time was 4.4 months on average,and full weight-bearing time averaged 5.5 months.Immediate postoperative radiography showed it had a good recovery for after the medial condyle angle,postoperative weight-bearing after 6 months,after the angle has no obvious lost,also did not see the medial condyle steps; An average of 105 ° of knee joint mobility in postoperative after 1 year; According to knee joint HSS score evaluation of curative effect： optimal 10（ 85points）,good（ 70 ~ 84）,4 cases（ 60 ~ 69 points） in 3cases,fine rate was 82.4%. No necrosis of incision,deep infection,without internal fixation loosening and other complications. Conclusions For fracture line without involved in distal tibial tubercle plane Schatzker V type and Schatzker Ⅵ type complex tibial plateau fractures,especially with coronary medial condyle fracture patients,because smaller by a broken inside,with double incision,three steel plate internal fixation treatment and reset will be more easy,more reliable. Moreover,the soft tissue around the knee is less injury,less complications and faster recovery of joint function. It is one of the recommended treatment methods in clinic.