联合入路双钢板内固定治疗Schatzker V、 VI型胫骨平台骨折的临床疗效分析

Clinical analysis of combined approach and double plate internal fixation for the treatment of Schatzker V, VI tibial plateau fractures

目的探讨联合入路双钢板内固定治疗Schatzker V、VI型胫骨平台骨折患者的手术疗效。方法 2015年3月—2017年5月华中科技大学同济医学院附属同济医院创伤中心手术治疗的Schatzker V、VI型胫骨平台骨折患者共49例,男性35例,女性14例;年龄26～67岁,平均43.2岁。所有患者采用联合入路双钢板内固定手术治疗,观察患者手术时间、术中出血量、术后并发症、骨折愈合时间及伤肢纽约特种外科医院(HSS)膝关节功能评分情况。结果 49例患者,手术平均时间(95.7±15.5)min,手术平均出血(262.9±33.2)mL,骨折平均愈合时间(4.5±1.6)个月。膝关节不稳2例,无伤口感染、骨折不愈合、畸形愈合病例。术后均门诊随访1年,术后1年伤肢采用HSS膝关节功能评分:优21例,良19例,中7例,差2例,术后膝关节优良率81.63%,术后膝关节功能较术前具有统计学意义(P<0.05)。结论采用联合入路双钢板内固定治疗Schatzker V、VI型胫骨平台骨折,固定稳定性较高,术后并发症较少,术后膝关节功能恢复率较高。

Objective To investigate the effect of the combined approach with double plate internal fixation in Schatzker V,VI tibial plateau fracture patients.Methods A total of 49 patients with Schatzker V and VI tibial plateau fractures who were surgically treated at our traumatic center between Mar.2015 and May 2017 were selected.All patients were treated with combined approach with double plate internal fixation.There were 49 males and 35 females with an average of 43.2(26-67)years.The operation time,blood loss,postoperative complications,fracture healing time and HSS scores of injured knee joint function were observed.Results In the 49 patients,the average operation time was(95.7±15.5)min,the mean bleeding was(262.9±33.2)mL,and the average healing time of fracture was(4.5±1.6)months.Knee instability happened in 2 cases,with no wound infection,fracture and nonunion and malunion cases.All patients were followed up for 1 year after operation.In the first year after operation,the HSS score of the knee joint was excellent in 21 cases,good in 19 cases,fair in 7 cases and poor in 2 cases.The rate of excellent and good was 81.63%.Postoperative knee function was statistically significant different from before treatment(P<0.05).Conclusion The combined approach with double plate internal fixation for the Schatzker V,VI type tibial plateau has advantages of high stability and few postoperative complications.The treatment of postoperative knee joints has a high recovery rate.