单与双钢板内固定治疗复杂胫骨平台骨折比较

Single plate versus double plates for internal fixation of complex tibial plateau fracture

[目的]评估采取双切口双钢板和单侧锁定钢板内固定治疗复杂胫骨平台骨折的临床效果。[方法]回顾性分析本科2015年8月~2017年10月手术治疗的60例胫骨平台骨折Schatzker分型V型和VI型患者的临床资料。30例采用单钢板内固定,30例采用双钢板内固定。对比两组临床疗效。[结果]两组患者均顺利完成手术,两组在手术时间、术中出血量、住院天数的差异无统计学意义(P>0.05)。双钢板组有3例患者皮缘缺血坏死、内固定外露,经相应处理后,最终切口均愈合。随访18个月以上,随术后时间推移,两组患者膝关节伸屈ROM和HSS评分均显著增加(P<0.05);末次随访时,双钢板组的膝关节伸屈ROM和HSS评分高于单钢板组,但差异无统计学意义(P>0.05)。影像显示骨折愈合时间单钢板组为(20.24±5.55)周,双钢板组为(20.61±8.62)周,差异无统计学意义(P>0. 05)。[结论]双切口双钢板和单侧锁定钢板内固定治疗复杂胫骨平台骨折的临床效果相当。

[Objective]To compare the clinical outcomes of single plate versus double plates for open reduction and internal fixation(ORIF)of complex tibial plateau fractures.[Methods]A retrospective study was conducted on 60 patients who underwent surgical treatment for Schatzker types V and VI tibial plateau fractures from June 2015 to May 2017 in our hospital.In term of internal fixation performed,30 patients had ORIF with a single locking plate used on the lateral side of the proximal tibia through anterolateral approach,while the remaining patients received ORIF with two plates used on bilateral sides of the proximal tibia through the anterolateral and posteromedial approaches.The clinical consequences were compared between the two groups.[Results]All the patients in both groups had operation performed successfully without significant differences regarding operation time,intraoperative blood loss and hospital stay between the two groups(P>0.05).Skin necrosis accompanied with implant exposure occurred in 3 patients of the double plates group,which eventually cured after corresponding management.As time went during the follow-up lasted for more than 18 months,the knee range of motion and HSS score significantly improved in both group(P<0.05).At the latest follow up,the double plates group had slight higher ROM and HHS score than the single plate group regardless of no statistical differences between them(P>0.05).Radiographic examinations revealed bony healing of the fractures achieved in(20.24±5.55)weeks in the single plate group,whereas(20.61±8.62)weeks in the double plates groups,which was not statistically significant(P>0.05).[Conclusion]Whatever single plate and double plates used in ORIF do achieve comparable clinical outcomes for complex tibial plateau fractures.