支撑钢板治疗Schatzker Ⅳ型胫骨平台骨折的临床效果

Clinical therapeutic effect of support plates on Schatzker Ⅳ tibial plateau fractures

目的探讨使用支撑钢板治疗SchatzkerⅣ型胫骨平台骨折的临床效果。方法选择2013年4月—2014年9月采用支撑钢板治疗SchatzkerⅣ型胫骨平台骨折患者。使用内侧切口或后内侧切口,必要时采用其他辅助切口,利用有限接触加压钢板、1/3管型钢板或"T"型钢板固定支撑骨折。结果共纳入患者14例,男6例,女8例;年龄20~52岁,平均(35.2±9.8)岁。14例患者均获得随访,随访时间12~25个月,平均(16.3±4.0)个月。术后1个月患者膝关节屈曲80~130°,平均(97.9±13.1)°;术后3个月膝关节屈曲90~140°,平均(119.3±12.1)°。术后1年膝关节美国特种外科医院膝关节临床功能评分78~96分,平均(88.4±4.9)分;末次随访时根据Rasmussen评分系统评定膝关节功能,优8例,良4例,可2例,优良率为85.7%。术后无患者出现感染、骨不愈合、血管神经损伤、内固定失效等并发症。结论支撑钢板治疗SchatzkerⅣ型胫骨平台骨折,既能有效达到维持复位,防止胫骨平台二期塌陷,又能保证膝关节对线对位良好,对血管神经等重要组织激惹少,手术并发症较少,膝关节功能较满意。

Objective To evaluate the clinical therapeutic effect of support plates on Schatzker type Ⅳ tibial plateau fractures. Methods Patients with Schatzker type Ⅳ tibial plateau fractures underwent support plates treatment between April 2013 and September 2014 by using the medial incision or posterior medial incision, if necessary, with other auxiliary incisions, with limited contact compression plate, 1/3 tubular plate or ＂T＂ plate to support the fracture. Results A total of 14 patients including 6 males and 8 females with an average age of（35.2±9.8） years（ranged from 20 to 52 years）were enrolled in this study and followed up for 12–25 months with an average of（16.3±4.0） months. The knee joints were flexed 80–130° with an average of（97.9±13.1）° one month after the surgery and 90–140° with an average of（119.3±12.1）°three months after the surgery. One year postoperatively, the mean Hospital of Special Surgery knee score ranged from 78 to 96 with an average of 88.4±4.9. Last follow-up assessment of knee function according to Rasmussen scoring system showed excellent in 8 cases, good in 4 cases, and fair in 2 cases; the excellent and good rate was 85.7%. No postoperative complications such as infection, nonunion, vascular nerve injury, or internal fixation failure occurred. Conclusion The support plates for the treatment of Schatzker type Ⅳ tibial plateau fractures can maintain good reduction, prevent the secondary collapse of the tibial plateau, ensure that knee joint has good alignment, less complications with vascular or nerve injuries, and finally get a satisfied function recovery.