外固定支架结合胫骨近端锁定钢板治疗胫骨平台复杂骨折

目的：通过应用外固定支架结合胫骨近端锁定钢板治疗胫骨平台骨折，观察临床疗效，探讨胫骨平台复杂骨折的治疗方法。方法：2006年2月至2008年10月，采用外固定支架结合胫骨近端锁定钢板治疗复杂胫骨平台骨折12例，男8例、女4例；年龄23～59岁，平均38岁。骨折按Sehazker分型：Ⅴ型7例，Ⅵ型5例。术中使用前内侧切口及前外侧切口，于胫骨外侧置入锁定钢板进行内固定。观察术前及术后X线片胫骨平台塌陷及高度丢失情况，对膝关节功能使用HSS评分法评分。结果：12例均获随访，时间4—18个月，平均9．79个月，骨折平均愈合时间3．1个月。骨折愈合11例，延迟愈合1例，无骨筋膜室综合征及下肢深静脉栓塞。术前、术后X线片对照检查未发生Ⅱ期胫骨平台塌陷及高度丢失，无对线不良，膝关节屈曲90°～110°。HSS评分术后平均（75．50±10．01）分，较术前平均（21．50±11．68）分有所提高。结论：外固定支架结合胫骨近端锁定钢板治疗复杂胫骨平台骨折提供了持续稳定的固定，防止骨折的Ⅱ期移位和膝关节力线的畸形，可以保护膝关节周围软组织，减少手术并发症，膝关节功能满意。

Surgical treatment of tibia plateau fractures with external fixator and the locking plate

Objective：To observe the clinical effect of the treatment for complex fractures of the tibial plateau through the application of the external fixator and the locking plate. Methods：From Feb. 2006 to Oct. 2008,12 patients with tibial plateau fractures were treated with external fixator and locking plate included 8 males and 4 females with an average age of 38 years ranging from 23 to 59. According to Schatzker type,7 cases were type V and 5 cases were type Ⅵ Using an anteromedial incision and an anterolateral approach, the locking plate were fixed in the tibia lateral. The collapse and height lossing of tibial plateau was observed through X-ray film before and after operation. The function of knee joint was evaluated according to HSS scoring. Results：These patients were followed up for 4 to 18 months （means 9.79 months）. Eleven eases had bone primary union,and 1 delayed union. No deep phlebothrombosis and osteofaseial compartment syndrome oecurened. The average healing time was 3.1 months. Between the preoperative and postoperative X-ray film there were no second stage depression fracture of the tibial plateau,postoperative reduction loss and bad alignment. The range of knee flexion was 90°to 110% The HSS knee functional scoring was （75.50± 10.01 ） scores after operation and （21.50± 11.68 ） scores before operation. Conclusion ：The treatment with the external fixator and the locking plate for complex fractures of the tibial plateau could provid continuous stability of fixation, prevent the fracture from second stage displacement and the knee force line change ,protect the soft-tissue around the knee, reduce the postoperative complications. The knee joint function is satisfied.