复杂胫骨平台骨折手术方法选择及疗效分析

目的探讨双钢板内固定术和经皮﹙有限切开﹚复位外固定术治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折的临床疗效.方法2007年5月~2009年12月,本科采用双切口双钢板内固定及经皮﹙有限切开﹚复位外固定术治疗27例 SchatzkerⅤ、Ⅵ型胫骨平台骨折患者,并对临床结果进行分析.结果术后27例均获随访,随访10~26月,平均17.6月.骨折均获得骨性愈合,骨折愈合时间5~10月,平均7.2月,膝关节功能评分采用Lysholm标准评定:优19、良6、可2,优良率92.6%.结论复杂胫骨平台骨折应视软组织损伤情况,选择合适固定方法及时机.软组织损伤较轻时选择双切口双钢板内固定,软组织损伤较严重时选择﹙有限切开﹚外固定术.因此,选择合适的手术方法和时机可减少软组织并发症,使骨折固定稳定,关节功能恢复满意.

Surgical strategy and efficacy analysis of complex tibial plateau fracture

Objective To discuss clinical outcomes of complex Schatzker type Ⅴand Ⅵ tibial plateau fractures treated with dual plates fixation and external fixation utilizing percutaneous reduction or limited open reduction technique respectively.Methods From May 2007 to Dec 2009,dual plates fixation with a two-incision approach and external fixation utilizing percutaneous reduction or limited open reduction technique were performed respectively in 27 patients with Schatzker type Ⅴ and Ⅵ tibial plateau fractures,and an analysis of clinical outcomes of treatment was made.Result All cases were followed up ranging 10 to 26 months with an average of 17.6 months.Bone healing occurred within 5 to 10 months with a mean time of 7.2 months.According to Lysholm criterion,the result of the treatment was evaluated as excellent in 19 cases,good in 6 cases and fair in 2 cases.The rate of excellent and good was 92.6%.Conclusion The choice of treatment of complex tibial plateau fractures bases on the extent of soft tissue injury before an appropriate operating procedure and surgical timing was made.If the soft tissue injury was relatively modest,dual plates fixation with a two-incision approach was suggested.While external skeletal fixation utilizing limited open reduction technique was preferred in cases with severe soft tissues injury.Selecting appropriate operating procedure and surgical timing could minimize the risk of soft tissue complication,obtain stable fixation with satisfactory joint function recovering.