依据改良Schatzker分型治疗164例复杂胫骨平台骨折

Modified Schatzker Classification in Treatment of 164 Cases with Complex Tibial Plateau Fractures

目的探讨复杂胫骨平台骨折改良Schatzker分型在复杂胫骨平台骨折(Ⅴ、Ⅵ型)治疗中的临床意义。方法分析2012-01/2016-12月在作者医院接受治疗并获得完整随访的164例SchatzkerⅤ、Ⅵ型胫骨平台骨折患者的病例资料。所有患者术前借助医学影像信息系统(picture archiving and communication system,PACS)系统测量患侧胫骨短缩长度,依据复杂胫骨平台骨折改良Schatzker分型分为:垂直压缩型56例(Ⅴa型22例、Ⅵa型34例)和非垂直压缩型108例(Ⅴb型31例、Ⅵb型77例)。比较各组患者受伤机制、合并伤、胫骨短缩长度、手术时间、术中出血量、手术复位情况、术后负重时间、胫骨平台内翻角和后倾角、Rasmussen放射学评分优良率、Lysholm评分综合分析复杂胫骨平台骨折改良Schatzker分型在复杂胫骨平台骨折治疗中的临床意义。结果 164例患者术后随访12~36个月(平均19.6个月)。垂直压缩型(Ⅴa、Ⅵa型)患者在受伤机制、是否存在合并伤、肢体短缩长度、手术时间、术中出血量、术后负重时间等方面与非垂直压缩型(Ⅴb、Ⅵb型)患者进行比较,存在统计学差异(P均<0.05)。依据复杂胫骨平台骨折改良Schatzker分型采用梯次个体化治疗后,末次随访时垂直压缩型与非垂直压缩型平台内翻角和后倾角、Rasmussen放射学评分优良率、膝关节Lysholm评分比较,均无统计学差异(P>0.05)。结论复杂胫骨平台骨折改良Schatzker分型能反映复杂垂直压缩型胫骨平台骨折的损伤机制及骨折特点,指导手术治疗中注重恢复患肢长度与力线,依据伤情采用梯次个体化治疗策略,可获得满意疗效。

Objective To investigate the clinical significance of modified Schatzker classification in treatment of complex tibial plateau fractures（typeⅤ andⅥ）.Methods From January 2012 to December 2016,164 complete followup cases with Schatzker typeⅤ and Ⅵtibial plateau fractures treated in authors＇ hospital were selected.The patients＇ injured limb length were measured by picture archiving and communication system before operation.According to the modified Schatzker classification of complex tibial plateau fractures,all patients were divided into two groups：56 cases were vertical compression type（subtypeⅤa in 22 cases andⅥa in 34 cases）and 108 cases were non-vertical compression type（subtypeⅤb in 31 cases andⅥb in 77 cases）.The clinical significance of modified Schatzker type in treatment of complex tibial plateau fracture were comprehensively analyzed by comparing the mechanism of injury,associated injuries,the length of the limb shortening,operative time,intraoperative blood loss,reduction,weight-bearing time,tibial plateau varus angle and caster angle,good rate of Rasmussen radiology score and Lysholm score in each group.Results All 164 patients were followed up from 12 to 36 months（average,19.6 months）.There were significantly different in injury mechanism,associated injuries,the length of the limb shortening,operation time,intraoperative blood loss,weight-bearing time and so on between vertical compression type（subtype Ⅴa,Ⅵa）and non-vertical compression type（subtypeⅤb,Ⅵb）（all P〈0.05）.At the last follow-up,there were no significant difference in the platform varus angle and caster angle,good rate of Rasmussen radiology score and Lysholm score between vertical compression type and non-vertical compression type after using echelon individualized treatment strategy based on modified Schatzker classification of complex tibial plateau fractures（P〉0.05）.Conclusion The modified Schatzker classification of complex tibial plateau fracture can reflect the damage mechanism and fracture characteristics,and provide guidance for recovery of the limb length and the force line of the complicated tibial plateau fracture.And using echelon individual treatment strategy according to the condition of the injuries can improve the curative effect of operation.