微创钢板固定法治疗高能量胫骨平台骨折

Minimally invasive plating for high energy tibial plateau fractures

目的通过前瞻性研究了解微创钢板法治疗复杂胫骨平台骨折的临床效果。方法从2002年1月～2002年10月共有17例(17膝)闭合性高能量胫骨平台骨折采用微创钢板法治疗。患者平均年龄45.3岁(20～66岁);其中左膝12例,右膝5例;男8例,女9例。按AO分型,41B型3例,41C型14例;按Schatzker分型,Ⅱ型2例,Ⅴ型4例,Ⅵ型11例。用改良内外侧联合切口,行微创钢板固定。术后1、3、6个月及1年随访患者,行摄片及关节活动度检查,测定胫骨平台内翻角(TPA)及胫骨平台后倾角(PA);术后1年行膝关节HSS评分。结果患者术后与术后1年TPA及PA平均值的差异无显著性(TPA:t=0.979,P=0.342;PA:t=0.659,P=0.519)。术后1年膝关节HSS评分平均为88.7分(75～98分)。本组患者无深部感染及内固定失败。结论微创钢板技术具有手术创伤小,切口及软组织并发症明显减少,骨折固定及时,长期的稳定性良好,关节功能恢复满意等优点,是治疗高能量胫骨平台骨折安全、有效的方法。

Objective A prospective study was conducted to evaluate the efficacy of minimally invasive plating (MIPO) for high energy tibial plateau fractures. Methods 17 cases of closed comminuted unstable tibial plateau fractures, 8 males and 9 females, were included in this study. Their mean age was 45.3 (20 66) yrs. According to AO classification, there were 3 cases of 41B and 14 cases of 41C; while by Schatzker classification, 2 cases were type Ⅱ, 4 cases were type Ⅴ, and 11 cases were type Ⅵ. An anterior lateral approach combined with a small posterior medial approach was used to reduce the risk of soft tissue complication. The main implant on the lateral side was inserted by minimally invasive method, leaving the blood supply around the fracture area undisturbed. All the patients were followed up at 1 month, 3 months, 6 months and 1 year postoperatively. Tibial plateau angle (TPA) and posterior slope angle (PA) of tibial plateau were measured to evaluate the stability of proximal tibia and knee alignment. HSS scoring was used as the parameter for knee function. Results The mean HSS score was 88.7(75 98)points one year after operation. Plate fixation was quite stable. The mean value of tibial plateau angle (TPA) and tibial plateau posterior tilting angle (PA) had no significant changes one year after operation (TPA: t= 0.979,P=0.342; PA: t = 0.659, P =0.519). The patients began full weight bearing at an average of 16.6 (9 27) weeks postoperatively, and their bony union was confirmed by X rays at an average of 15.4 (10 28) weeks postoperatively. The mean range of motion was from extension of 1.8°( 5° 5°) to flexion of 124°(120° 135°). No deep infection or other soft tissue complications were found in this group. Conclusion Minimally invasive plating is a safe and effective way to treat high energy tibial plateau fractures, for it provides rigid fixation for the fracture with low risk of soft tissue complications and good recovery of knee function.