改良前外侧直切口内固定治疗胫骨平台骨折的疗效

The effect of the modified anterolateral straight incision internal fixation for treatment of tibial plateau fracture

目的探讨改良前外侧直切口内固定治疗胫骨平台骨折的临床疗效。方法采用改良前外侧直切口接骨板内固定治疗42例胫骨平台骨折患者。根据DeCoster et al分级标准评估胫骨平台关节面复位情况。记录骨折愈合情况、膝关节HSS评分、关节活动度以及术后并发症发生情况。结果患者均获得随访,时间6~18个月。术后根据DeCoster et al分级标准评价胫骨平台关节面复位情况:优36例,可6例。骨折均愈合,时间10~16周。患者弃拐完全负重时间12~18周,行走活动时无跛行及膝关节疼痛等症状。随访期间未发生骨折再移位、关节不稳定、内固定松动等并发症。末次随访时采用膝关节HSS评分评价疗效:优32例,良6例,可4例,优良率90.5%;膝关节伸直0°~5°,屈曲100°~135°;踝关节无僵硬,活动正常,背伸20°~30°,跖屈40°~50°。结论改良前外侧直切口内固定治疗胫骨平台骨折,术中可保护髂胫束,既能满足术区暴露的同时又能尽量减少手术创伤,并发症少,术后患者膝关节功能恢复快,疗效满意。

Objective To investigate the clinical effect of modified anterolateral straight incision internal fixation in the treatment of tibial plateau fractures.Methods Forty-two patients with tibial plateau fractures were treated with plate internal fixation via modified anterolateral straight incision.The reduction of articular surface of tibial plateau was evaluated according to the DeCoster et al grading criteria.The fracture healing,HSS score of knee joint,range of motion(ROM)of the knee,and postoperative complications were recorded.Results All patients were followed up for 6~18 months.According to the DeCoster et al grading criteria,the reduction of articular surface of tibial plateau was excellent in 36 cases,fair in 6 cases.All fractures healed within 10~16 weeks.The time of full weight-bearing without crutch was 12~18 weeks,there was no symptoms of claudication or knee pain during walking.During the follow-up,no complications such as fracture re-displacement,joint instability,and internal fixation loosening occurred.At the last follow-up,HSS score was used to assess the efficacy,the result was excellent in 32 cases,good in 6 cases,and fair in 4 cases,with an excellent-good rate of 90.5%.Knee ROM was extension with 0°~5°,flexion with 100°~135°.The ankle joint had no stiffness,with normal movement,the dorsiflexion was 20°~30°and the plantar-flexion was 40°~50°.Conclusions The modified anterolateral straight incision internal fixation for tibial plateau fractures can protect the iliotibial band during the operation,which can not only meet the exposure of the operation area,but also reduce the surgical trauma as far as possible,with fewer complications,faster recovery of knee joint function,and satisfactory results.