MIPPO双钢板固定与单钢板加空心螺钉固定治疗Schatzker Ⅴ、Ⅵ型胫骨平台骨折疗效比较

Comparison effects of MIPPO combined with double-plates and single-plate combined with compressive hollow screws internal fixation for treatment of Schatzker type Ⅴ,Ⅵ tibial plateau fractures

目的比较MIPPO双钢板固定与单钢板加空心螺钉固定技术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折的临床疗效。方法将42例SchatzkerⅤ、Ⅵ型胫骨平台骨折患者按治疗方法分为两组,分别采用切开复位单侧锁定钢板加空心拉力螺钉内固定(单钢板加空心螺钉组,20例)和MIPPO双钢板内固定(MIPPO双钢板组,22例)。比较两组的手术时间、术中出血量、骨折愈合时间、膝关节功能HSS评分以及胫骨平台内翻角(TPA)和胫骨平台内侧后倾角(PSA)的变化。结果患者均获得随访,时间12~18(15±2.8)个月。两组手术时间、术中出血量、术后3 d及术后6个月时TPA、PSA比较差异均无统计学意义(P>0.05);骨折愈合时间MIPPO双钢板组少于单钢板加空心螺钉组(P<0.05);术后12个月单钢板加空心螺钉组塌陷较MIPPO双钢板组严重(P<0.05);术后12个月膝关节HSS功能评分MIPPO双钢板组优于单钢板加空心螺钉组(P<0.05)。结论采用MIPPO双钢板内固定技术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折疗效理想,具有创伤小、固定牢靠、可早期功能锻炼、并发症少等优点。

Objective To compare the clinical effects of type Ⅴ,Ⅵ tibial plateau fractures treated with MIPPO combined with double-plates and single-plate combined with compressive hollow screws.Methods The 42 patients with the tibial plateau Schatzker type Ⅴ,Ⅵ fractures were divided into two groups.Twenty patients were treated with single-plate combined with compressive hollow screws internal fixation,and 22 patients were treated with MIPPO combined with double-plates internal fixation.The operative time,intra-operative bleeding,healing time of fracture,HSS scores of the knee joint function,tibial plateau-tibial shaft angle（TPA） and posterior slope angle（PSA） were compared.Results All the patients were followed up for 12~18（15±2.8） months.There were no statistical significance between two groups＆#39; mean operation time,blood loss volume,TPA and PSA at 3 d and 6 months （P〉0.05）.The fracture healing time of the group of MIPPO combined with double-plates was less than the group of single-plate combined with compressive hollow screws（P〈0.05）.At 12 months postoperation,the collapse degree of tibial plateau collapse in the group of single-plate combined with compressive hollow screws was more serious than that in the group of MIPPO combined with double-plates（P〈0.05）,and the HSS score of the group of MIPPO combined with double-plates was better than that of the group of single-plate combined with compressive hollow screws （P〈0.05）.Conclusions The method of MIPPO combined with double-plates internal fixation has good satisfactory therapeutic effects on treating tibial plateau Schatzker type Ⅴ,Ⅵ fractures,and has advantages of minimal invasive aspect,strong fixation,early functional training of postoperation and less complication.