复杂胫骨平台骨折手术临床疗效分析及手术入路探讨

Evaluation on the optimal approach to treatment of complex tibial plateau fractures and clinical efficacies

目的:探讨正中单切口与内外侧双切口双钢板治疗复杂胫骨平台骨折的临床疗效及预后。方法:本研究共纳入复杂胫骨平台骨折患者20例(Schatzker V型10例、Ⅵ型10例),均行手术复位、植骨、双钢板固定,其中10例患者行单切口双钢板治疗,10例患者行双切口双钢板固定,收集两组患者的基本资料,观察两组的手术时间、术中出血量、术后并发症、骨折愈合时间及术后患肢功能恢复情况。结果:两组间在患者年龄、性别、治疗时间窗等方面无明显差异,双切口双钢板治疗组在手术时间[(75.9±1.9)vs.(89.0±3.0)min]及骨折愈合时间[(143.0±8.7)vs.(173.2±5.0)d]均明显优于单切口双钢板治疗组,近期预后方面也明显优于单切口入路组。按照膝关节功能Rasmussen评分可以发现双切口双钢板组优8例,良1例,可1例;而单切口双钢板治疗组优7例,良1例,可2例;两组在膝关节功能恢复优良率方面具有显著差异。结论:双切口双钢板内固定治疗复杂胫骨平台骨折临床效果显著,在手术时间、骨折愈合时间等方面优于单切口治疗组,更有利于膝关节功能的恢复。

Objective：To compare the efficacies and prognosis of single midline incision technique and two-small-incision technique by double plate fixation in the treatment of complex tibial plateau fractures.Methods：Twenty patients with complex tibial plateau fractures （Schatzker type Ⅴ in 10 cases,and type Ⅵ in 10）were included.Ten patients received double plate fixation by single midline incision technique and another 10,double plate fixation by two-small-incision technique.General data were obtained in the two groups and compared regarding the operative time,intraoperative blood loss,postoperative complications,fracture healing and function recovery.Results：The two groups of patients had no significant difference concerning the age,gender and therapeutic time window,yet two-small-incision technique was superior to the single midline incision in operative time[（75.9±1.9）min vs.（89.0±3.0）min],fracture healing time[（143.0±8.7）d vs.（173.2±5.0）d] and short-term prognosis.Rasmussen′s knee functional scoring indicated excellent recovery in 8 patients,good in 1 and fair in another 1 in patients treated by double plate fixation with two-small-incision technique compared to 7,1,and 2,respectively,in those treated with single midline incision.The difference was significant.Conclusion：Double plate fixation of the complex tibial plateau fractures via two-small-incision technique can lead to significantly better clinical efficacies, shortened operative time fracture healing time, and better recovery of the knee function following surgery.