术前术中外固定架联合单侧锁定接骨板治疗复杂胫骨平台骨折

Preoperative and intraoperative application of external fixator combined with unilateral locking plate in the treatment of complex tibial plateau fractures

背景:复杂胫骨平台骨折常会伴随严重的周围软组织损伤。手术治疗可能会加重软组织损伤。目的:探讨手术前及手术中应用外固定架联合单侧锁定接骨板固定治疗复杂胫骨平台骨折的疗效。方法方法:回顾分析2009年6月至2013年10月采用术前术中应用外固定架联合单侧锁定接骨板固定治疗的29例复杂胫骨平台骨折患者。骨折按Schatzker分型:V型12例,Ⅵ型17例;按AO分型:C1型19例,C2型10例。就诊后及早进行闭合复位跨膝关节外固定架固定,软组织条件改善后二期手术中应用外固定架辅助复位,单侧锁定接骨板作最终内固定。结果结果:29例患者术后随访12~24个月,平均16.4个月。患者骨折愈合时间平均为3.7个月,完全负重时间平均为5.1个月。切口因脂肪液化延迟愈合2例,无深部感染病例。根据膝关节Rasmussen评分系统评定疗效:优14例,良11例,中3例,差1例,优良率为86.2%。术后即刻胫骨平台内翻角、胫骨平台后倾角及股胫角与术后1年比较差异均无统计学意义(P>0.05)。结论论:对复杂胫骨平台骨折,术前术中应用外固定架对软组织恢复及骨折复位有明显帮助,单侧锁定接骨板内固定可满足术后早期功能锻炼要求,术后并发症少,疗效满意。

Background： Complex tibial plateau fractures are often accompanied by severe peripheral soft tissue lesions.Surgical treatment may aggravate the injury of soft tissues. Objective： To explore clinical outcomes of external fixator combined with unilateral locking plate for complex tibial plateau fractures before and during internal fixation. Methods： A total of 29 patients with complex tibial plateau fractures, who were treated with preoperative and intraoperative external fixator combined with unilateral locking plate between June 2009 and October 2013 were retrospectively analyzed. According to the Schatzker typing, there were 12 cases of type V and 17 cases of type VI. According to the AO typing, there were 19 cases of C1 and 10 cases of C2. Closed reduction and external fixator across the knee were applied to the patients once they were admitted to the hospital. External fixator for auxiliary restoration was applied in the second-stage operation after recovery of soft tissues. Unilateral locking plate was finally used for internal fixation. Results： All the patients were followed up for 16.4 months on average（range, 11-24 months）. The mean fracture healing time was 3.7 months and full weight-bearing time was 5.1 months. There were 2 cases of delayed incision healing due to fat liquefaction. No deep infection was found.According to Rasmussen score of knee joint function, the outcome was excellent in 14 cases, good in 11, fair in 3 and poor in one. The excellent and good rate was 86.2%. There was no significant difference in the tibial plateau-tibial shaft angle,posterior slope angle of the tibial plateau, or the femoral shaft-tibial shaft angle immediately after the operation as compared with those at one year after the operation（P〉0.05）. Conclusions： Preoperative and intraoperative application of external fixator can be helpful to the recovery of soft tissues and the reduction of fracture for patients with complex tibial plateau fractures. Unilateral internal fixation through locking plate meets the requirement of the early function rehabilitation. The efficacy is satisfactory as there are fewer complications after the operation.