有限内固定结合外固定支架与钢板治疗胫骨平台骨折的疗效分析

[目的]探讨有限内固定结合外固定支架与钢板在胫骨平台骨折治疗中的应用及其疗效.[方法]2007年1月～2011年1月从胫骨平台骨折患者中选取58例,男38例,女20例；年龄19～ 54岁,平均(42.7±8.9)岁,按Schatzker分型:Ⅳ型17例,Ⅴ型31例,Ⅵ10例,其中外支架组31例,钢板内固定组27例,术后随访6～17个月,平均14.1个月.[结果]有限内固定结合外支架固定组平均手术时间(57.4±12.1)min,平均术中出血量(161.3±17.0) ml,平均骨折愈合时间为(12.4±1.5)周,切口感染率为6％,针道感染率为9％,Lysholm评分:优21例,占67％,良8例,占25％,差2例.钢板内固定治疗组平均手术时间(105.4±23.8) min,平均术中出血量(252.4±28.9)ml,平均骨折愈合时间为(15.5±2.5)周,切口感染率为4％,Lyshol评分:优16例,占60％,良10例,占37％,差1例.手术时间、术中出血量、骨折愈合时间,评分组间比较有显著差异(P＜0.05),切口感染率、Lysholm评分组间无显著差异(P＞0.05).[结论]两种方法治疗胫骨平台骨折,功能恢复佳,疗效满意,外固定架是目前治疗胫骨平台开放性骨折较为理想的治疗方式,尤其适用于胫骨平台骨折合并有严重的软组织损伤与缺损患者.

The analysis of limited internal fixation combined with external fixation and plate fixation for tibial plateau fracture

[Objective]To observe effect and application of limited internal fixation combined with external fixation and plate fixation for tibial plateau fracture.[Method]From Jan.2007 to Jan.2011,58 patients received surgical treatment,with 38 males and 20 females,aged from 19-54 years,the average age was 42.7 years.According to type Schatzker:17 cases were type Ⅳ,31 cases were type V,10 cases were type Ⅵ.Thirty-one cases were treated with limited internal fixation combined with external fixation,the other(27 cases) were treated with plate fixation.The mean follow-up were 14.1 months(from 6 to17 months).[Result]For the group of limited internal fixation combined with external fixation,the average operative time was 57.4 min,the blood loss in patients was(161.3±17.0)ml,the average fracture healing time was(12.4) weeks.The wound infection rate was 6%,the needle infection rate was 9%.According to the Lysholm evaluation,the results were excellent in 21 cases(67%),good in 8 cases(25%),fair in 2 cases.For the group of plate fixation,the average operative time was 105.4 min,the blood loss in patients was(252.4±28.9)ml,the average fracture healing time was(15.5) weeks,the wound infection rate was 4%.According to the Lysholm evaluation,the results were excellent in 16 cases(60%),good in 10 cases,(37%),fair in 1 case.There was significantly different in the operative time,blood loss and bone healing time between the two groups(P<0.05).There was no significant difference in wound infection and Lysholm score between groups(P>0.05).[Conclusion]Both methods in treating fracture of tibia plateau all have good functional recovery and satisfactory therapeutic effect.Limited internal fixation combined with external fixation treatment is more ideal for open tibial plateau fracture,especially for tibial plateau fractures with severe soft tissue injury and tissue defects.