双板内固定治疗复杂胫骨平台骨折

Treatment of complex tibial plateau fractures with double plate internal fixation

目的评价双板内固定治疗复杂胫骨平台骨折的临床疗效。方法对2013年3月至2015年3月普宁市人民医院采用双切口双板内固定治疗的32例SchatzkerⅤ、Ⅵ型胫骨平台骨折患者的临床资料进行回顾性分析,记录手术时间、术中出血量、骨折愈合时间及并发症发生情况,根据Rasmussen评分标准评估临床疗效。结果平均手术时间110 min(90~120 min),平均术中出血量230 m L(200~250 m L)。所有患者获随访12~18个月(平均14个月)。骨折愈合时间3~4个月(平均3.2个月);1例开放性骨折术后出现胫骨结节软组织缺损、骨外露,1例切口皮缘坏死,处理后均痊愈,无骨髓炎、关节感染、骨不连、内固定松动断裂并发症发生;末次随访按Rasmussen评分标准:优18例、良9例、可4例、差1例,优良率84%(27/32)。结论双板内固定治疗复杂胫骨平台骨折可获得良好复位和坚强内固定,骨折愈合良好,临床疗效满意。

Objective To evaluate the clinical effect of double plate internal fixation in the treatment ofcomplex tibial plateau fractures.Methods Clinical data of32patients with SchatzkerⅤandⅥtibial plateaufractures underwent double plate internal fixation from March2013to March2015in Puning People's Hospitalwere analyzed retrospectively.The operative time,intraoperative estimate blood loss,time of fracture healing andthe incidence of complications were recorded,clinical efficacy of patients were accessed according to Rasmussenscoring.Results The mean operative time was110min(90to120min),intraoperative estimate blood loss was230mL(200to250mL).All patients were followed up for an average of14months(12to18months).Themean fracture healing time was3.2months(3to4months);Soft tissue defect and bone exposure at tibialtubercle occurred in a open fracture case,and1case was suffered from necrosis of surgical margins,which werecured at last;No complications of osteomyelitis,joint infection,bone nonunion,loosening or breakage of internalfixators had happened;At the last follow-up,there were18cases of excellent,9good,4fair,and1poor,withthe excellent and good rate was84%(27/32)according to Rasmussen scoring.Conclusion Double plate internal fixation is a kind of effective treatments with good reduction,rigid internal fixation,good fracture healing andsatisfactory clinical efficacy for complex tibial plateau fractures.