内侧支撑钢板及排钉固定治疗累及后外侧SchatzkerⅣ型胫骨平台骨折的疗效分析

Treatment of Schatzker typeⅣtibial plateau fracture involving the postero-lateral condyle with a medial support plate and a row of screws

目的探讨使用内侧支撑钢板及排钉固定治疗累及后外侧SchatzkerⅣ型胫骨平台骨折的疗效。方法回顾性分析2015年12月至2020年12月西安交通大学医学院附属红会医院创伤骨科收治的26例累及后外侧SchatzkerⅣ型胫骨平台骨折患者资料,其中男17例,女9例;年龄为19~51岁,平均36.1岁;所有患者骨折线均累及后外侧胫骨平台,采用内外侧双切口内侧支撑钢板及排钉固定治疗。记录患者手术时间、住院时间、出血量、切口长度、骨折愈合情况、并发症、末次随访时膝关节复位质量、膝关节功能等情况。结果本组患者手术时间为80~200 min,平均140.3 min。26例患者术后获8~18个月(平均14.3个月)随访。所有患者骨折均愈合,骨折愈合时间为11~17周,平均13.7周;随访过程中未见复位丢失,内固定失败、手术相关并发症出现。末次随访时Rasmussen放射评分为11~18分,平均16.1分。膝关节活动度0~140°,平均120.8°。膝关节功能Rasmussen评分为14~28分,平均24.4分。结论对于累及后外侧的SchatzkerⅣ型胫骨平台骨折使用内侧支撑钢板及排钉固定治疗可以取得满意的疗效。

Objective To investigate the clinical efficacy of a medial support plate and a row of screws in the treatment of Schatzker typeⅣtibial plateau fracture involving the postero-lateral condyle.Methods A retrospective analysis was performed of the data of 26 patients who had been admitted to Department of Orthopedic Trauma,Honghui Hospital Affiliated to Xi'an Jiaotong University for Schatzker typeⅣtibial plateau fracture involving the postero-lateral condyle from December 2015 to December 2020.There were 17 males and 9 females,aged from 19 to 51 years(average,36.1 years).All their fracture lines involved the postero-lateral condyle and all fractures were fixated with a medial support plate and a row of screws via one medial and one lateral incisions.Recorded were the operation time,hospital stay,blood loss,incision length,fracture healing,complications,quality of knee joint reduction and knee joint function at the last follow-up.Results The length of hospital stay ranged from 8 to 16 days,averaging 10.4 days.The 26 patients were followed up for 8 to 18 months,with an average of 14.3 months.All the fractures got united after 11 to 17 weeks(average,13.7 weeks).During the follow-up,no reduction loss,internal fixation failure or surgical complications were observed.Rasmussen radiographic scores at the last follow-up ranged from 11 to 18 points,averaging 16.1 points.The range of motion of the knee joint ranged from 0°to 140°,averaging 120.8°.The Rasmussen scores of the knee function ranged from 14 to 28 points,averaging 24.4 points.Conclusion In the treatment of Schatzker typeⅣtibial plateau fracture involving the postero-lateral condyle,the use of a medial support plate and a row of screws can achieve satisfactory clinical results.