Minimal internal fixation augmented by small wire transfixion frames for high-energy tibial plateau fractures

PURPOSE: To evaluate the outcome of bicondylar tibial plateau fractures treated with minimal internal fixation augmented by small wire external fixation frames and to assess the necessity of bridging the knee joint by extending the external fixation to the distal femur. METHODS: This is a retrospective study of 48 tibial plateau fractures. There were 40 (83.5%) Schatzker type VI fractures, 8 Schatzker type V fractures, and 18 (37.5%) fractures were open. A complex injury according to the Tscherne-Lobenhoffer classification was recorded in 30 (62.5%) patients. All fractures were treated with combined minimally invasive internal and external fixation. Closed reduction was achieved in 32 (66.6%) of the fractures. Extension of the external fixation to the distal femur was done in 30 (62.5%) fractures. Results were assessed according to the criteria of Honkonen-Jarvinen. RESULTS: Follow-up ranged from 28 to 60 months with an average of 38 months. All fractures but 1 united at an average of 13.5 weeks (range 11-18 weeks). One patient developed an infected nonunion of the diaphyseal segment of his fracture. Thirty-nine (81%) patients achieved an excellent or good radiologic result. An excellent or good final clinical result was recorded in 36 patients (76%). Bridging the knee joint did not affect significantly the result (P < 0.418). No significant correlation was found between the type of fracture and the final score (P < 0.458). CONCLUSIONS: Hybrid internal and external fixation combined with tibiofemoral extension of the fixation is an attractive treatment option for complex tibial plateau fractures.     

Treatment of complex (Schatzker Type VI) fractures of the tibial plateau with circular wire external fixation: retrospective case review

OBJECTIVE: To determine the effectiveness of circular wire external fixation in the treatment of complex (Schatzker Type VI) fractures of the tibial plateau. DESIGN: Retrospective case series. SETTING: Fifty-seven complex (Schatzker Type VI) fractures of the tibial plateau were treated with circular wire external fixation at a Level 1 trauma center. PATIENTS: Thirty-five fractures were closed, and twenty-two were open. INTERVENTION: Closed indirect reduction by ligamentotaxis was attempted in all fractures; limited open reduction was performed in seven. Conventional Ilizarov frames using wire fixation were used in thirty-two fractures. The remaining twenty-five fractures were treated with hybrid Ilizarov fixators, which differed from conventional Ilizarov frames only in the use of cortical bone pins rather than wires through the distal rings for fixation of the diaphysis. MAIN OUTCOME MEASUREMENT: The results were graded according to the Knee Society rating system. Follow-up ranged from 16 to 90 months and averaged 42 months. RESULTS: All fractures united at an average of 173 days (range, 50 to 415 days). Forty-five fractures with anatomic reduction had an average knee score of eighty-three and an average functional score of sixty-nine. In nine fractures with nonanatomic reduction, the average knee score was fifty-two, and the functional score was nineteen. CONCLUSIONS: Results perhaps would have been improved by more frequent open reduction, bone grafting, and internal fixation of fractures with severely depressed articular fragments. However, the use of circular external fixation obtained results comparable with other series, and we believe it is appropriate for treatment of these complex tibial fractures, especially those with a poor soft-tissue envelope.     

Management of high-energy bicondylar tibial plateau fractures by minimal internal fixation and the ilizarov frame: the knee function

Background

Management of comminuted bicondylar tibial plateau fractures remains a challenge to orthopedic surgeons. Studies of long-term outcomes of treatment of the tibial plateau have included a mixture of fracture types, including low-energy split and split-depressed fractures. Thus, the middle- to long-term results of management of high-energy fractures are still lacking. The aim of this study was to evaluate the knee function and development of arthrosis after a minimum of 3 years in high-energy tibial plateau fractures treated by the Ilizarov external fixator.

Methods

This is a retrospective study performed at an academically supervised level III, trauma center, in which percutaneous and/or limited open internal fixation and an Ilizarov frame were applied for displaced bicondylar high-energy tibial plateau fractures (Schatzker types V and VI, and Orthopedic Trauma Association types C1, C2, and C3). There were 55 patients in this study and they were followed for a minimum of 3 years. Completion of the Iowa knee score, and the Short Form-36 (SF-36) General Health Survey, was a must.

Results

After healing, none of the studied patients needed a secondary reconstructive procedure. The knee motion ranged between 15° of extension and 155° of flexion, with an average of 88 % of the total arc of the contralateral knee. The average Iowa knee score was 94 points (range, 65 to 100 points), at the final follow-up visit. Twenty-eight patients rated their outcome as excellent; 17, as good; and 10, as fair. All the studied patients returned to their previous original works. Thirty-five of them were performing strenuous labor. At the final follow-up visit, there were arthrosis grade 1 in the X-rays of 25 patient, grade 2 in 10, grade 3 in 2, and no evidence of arthrosis was found in 18 X-rays (grade 0). Compared with the radiographic appearance 3 years after surgery, there was no evidence of progression of arthrosis in 42 patients, while arthrosis progressed for one grade in 13 patients. The SF-36 subscale scores were similar to those of age-matched controls.

Conclusion

Patients suffering from high-energy bicondylar tibial plateau fractures could be safely treated by minimal internal fixation and Ilizarov external fixation. This procedure has good prognosis for satisfactory knee function for up to 16 years of follow-up. The intra-articular displacement should be reduced properly, and only very minimal displacements are accepted. This leads to a better knee function and low arthrosis rate.     

Management of high-energy tibial plateau fractures by Ilizarov external fixator

Background

Despite the evolution of surgical techniques and implants, high energy tibial plateau fractures remain a challenging problem. The goals of treatment are to obtain a well-aligned stable joint with a painless functional range of motion and prevention of posttraumatic arthritis. Indirect reduction techniques and other soft tissue preservation methods safeguard the vascularity and emphasize restoring both joint congruity and the mechanical axis of the limb. The aim of this study was to evaluate the clinical outcome of using Ilizarov external fixator in the treatment of Schatzker type V–VI tibial plateau fracture.

Methods

This study was done during the period 2009–2011 for the treatment of 30 patients with high energy tibial plateau fractures (Schatzker type V in 17 and type VI in 13 patients) by Ilizarov external fixator. The mean age was 36 years .There were 23 males. The right limb was affected in 17 patients. There were 10 open fractures and other associated injuries in 9 patients.

Results

The mean of follow up period was 18 months. All the fractures were united in an average time of 15 weeks. There were pin track infection in 20 patients and other few complications in 8 patients. According to knee society score, there was an excellent result in 16.7 %, good in 60 %, fair in 20 %, and poor in 3.3 %.

Conclusion

Ilizarov external fixation is a safe and effective treatment option for high energy tibial plateau fractures with good functional results.     

关节镜下外固定架牵引复位治疗胫骨平台骨折

目的探讨在关节镜监视下结合外固定架牵引复位治疗胫骨平台骨折的临床疗效。方法2003年2月至2005年1月共治疗26例胫骨平台骨折患者,Schatzker分型为:Ⅰ型4例,Ⅱ型5例,Ⅲ型4例,Ⅳ型6例,Ⅴ型5例,Ⅵ型2例。术前摄X线片和CT扫描,术中在关节镜监视下对膝关节行外固定架牵引复位,通过螺钉或钢板进行内固定。根据Rasmussen评分对术后疗效进行评定。结果所有患者均获得随访,随访时间7～21个月,平均16个月。术后在1．5～4个月骨性愈合,未出现切口愈合不良、感染和筋膜间隔综合征等并发症,在随访期间未发生创伤性关节炎和膝关节内翻、外翻畸形。根据Rasmussen评分,11例为优,13例为良,2例可,本组平均为(27±2)分。结论采用关节镜监视下结合外固定架牵引复位技术治疗SchatzkeⅠ～Ⅵ型胫骨平台骨折,具有创伤小、骨折愈合快等优势,可增大关节腔内的操作间隙,提高骨折复位的准确性,有利于膝关节功能恢复。     

有限内固定联合外固定支架治疗Schatzker Ⅴ、Ⅵ型胫骨平台骨折

目的探讨有限内固定联合外固定支架治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折的临床疗效。方法手术治疗55例SchatzkerⅤ型(31例)和Ⅵ型(24例)胫骨平台骨折患者。术中先透视下闭合复位或辅以小切口复位胫骨平台内外侧髁,并给予螺钉固定,再应用外固定支架固定,对塌陷骨折撬拨复位人工骨填充。结果骨折解剖复位39例,近解剖复位16例。患者均获得随访,时间12~54个月。骨折愈合时间4~7个月。末次随访膝关节功能按Rasmussen评分标准:优32例,良15例,可7例,差1例,优良率85.5%。切口并发症7例(12.7%):其中切口浅表感染2例,钉道感染5例,未发生深部感染,骨髓炎及骨不连。结论有限内固定联合外固定支架治疗SchatzkerⅤ、Ⅵ型胫骨平台骨折可获得满意临床疗效,具有创伤小、并发症发生率低、骨折愈合快等优点。     

内固定与外支架固定治疗复杂性胫骨平台骨折的对比研究

目的比较单纯内固定与有限内固定加外固定支架治疗复杂性胫骨平台骨折的效果及优缺点。方法2002年7月-2006年8月，收治复杂性胫骨平台骨折66例，分成内固定组和外固定支架组。内固定组39例，其中男25例，女14例；年龄18～79岁，平均45．4岁。按照Schatzker分型，Ⅳ型18例，Ⅴ型7例，Ⅵ型14例。外支架固定组27例，其中男18例，女9例；年龄18～64岁，平均44．2岁。按照Schatzker分型，Ⅳ型13例，Ⅴ型6例，Ⅵ型8例。两组一般资料比较差异均无统计学意义（P〉O．05）。按照内固定原则分别采用螺钉、钢板或外固定支架固定进行治疗。结果患者均获随访，随访时间1～5年，骨折均达临床愈合，无骨不连发生。内固定组2例出现局部皮肤感染、坏死，经换药、皮瓣移位后治愈；骨折愈合时间6～14个月，平均7．3个月：内固定取出时间6～15个月，平均8．3个月。外固定支架组11例于术后7d～3个月出现针道流液，局部皮肤发红，3例出现皮肤坏死，3例在随访中发现螺栓松动，经清创、换药、植皮等处理创面愈合；骨折愈合时间为3～11个月，平均5．1个月；拆除外支架时间为5～11个月，平均6．4个月。术后8～14个月，参照Merchant等标准评定膝关节功能，内固定组优29例，良4例，中5例，差1例；外固定支架组优20例，良3例，中2例，差2例；两组膝关节功能比较差异无统计学意义（P〉0．05）。结论单纯内固定与有限内固定加外固定支架治疗复杂性胫骨平台骨折的效果相当，对于SchatzkerⅣ、Ⅴ、Ⅵ型胫骨平台骨折，应根据患者受伤情况、骨质条件选择固定材料。     

Modified hybrid fixator for high-energy Schatzker V and VI tibial plateau fractures

High-energy tibial plateau fractures associated with severe soft tissue injury are difficult to manage. The risk of wound complications following open reduction and internal fixation is notably high owing to extensive soft tissue dissection. Alternatively, application of hybrid external fixator minimizes soft tissue dissection and provides adequate fracture stabilization to allow early range of motion and correction of any mal-alignment. With this technique, soft tissue complications particularly surgical site infections are expected to be significantly reduced. This prospective study aims to determine the effectiveness of a modified hybrid external fixator in the management of high-energy tibial plateau fractures. Thirty-three patients with high-energy Schatzker V and VI tibial plateau fracture with severe soft tissue injury precluding formal open reduction were enrolled into the study. The fixator was a construct combining the Ilizarov ring with a monolateral external fixator. The results—bony union, range of motion, and associated complications of the treatment—were assessed. All fractures united within an average time of 14 weeks. Neither loss of reduction nor surgical site wound breakdown/osteomyelitis was noted. Eight patients developed superficial pin track infection and one septic arthritis of the knee joint. Hybrid external fixation is a safe option for complex high-energy tibial plateau fractures by simultaneously providing adequate fracture stabilization and protection of soft tissue healing to achieve bony union. The complication is mainly related to pin tract infection.     

Indirect reduction and hybrid external fixation in management of comminuted tibial plateau fractures

The aim of the present study is to assess the results of indirect reduction and hybrid external fixation in management of comminuted tibial plateau fractures. The study included 28 patients with high-energy tibial plateau fractures (Schatzker type V and VI). The ages ranged from 22 to 58 years with an average of 35 years. The trauma was a road traffic accident in 16 cases and a fall from a height in 12 cases. Concomitant soft tissue injuries were present in 18 cases such as skin wounds in 6 cases, excessive swelling with skin blisters in 9 cases, and compartment syndrome in 3 cases. After clinical and radiological evaluation all the patients were treated by indirect reduction using a traction table and a hybrid external fixator. The average time to healing was 3.2 months. At the final follow-up the range of knee movement ranged from 0 degrees-140 degrees with an average of 110 degrees. The results were satisfactory in 23 cases and unsatisfactory in 5 cases according to the Rasmussen knee functional score. Complications included pin tract infection in 12 cases, an extension lag in 2 cases, varus deformity of about 15 degrees in one case, deep infection in one case and early osteoarthritic changes in 2 cases. Hybrid external fixation is a good method for treatment of comminuted tibial plateau fractures. It allows for early joint movement and reduces the risk of serious complications.     

Open reduction and internal fixation versus hybrid fixation for bicondylar/severe tibial plateau fractures: a systematic review of the literature

Introduction  Bicondylar/Schatzker 6 type tibial plateau fractures are a significant challenge to the trauma and orthopaedic surgeon. These injuries tend to be complex, high energy and are activated with significant morbidity. Two surgical methods are commonly in use: (1) hybrid external fixation or (2) internal fixation. We performed a systematic analysis of papers comparing these two techniques. Methods  The Medline database was used and the MeSH terms associated with bicondylar/severe tibial plateau fractures were inserted. Results  Forty-nine studies were retrieved but only five papers presented data to directly compare the two techniques as these studies actually compared the implants. Study designs and outcome measures were not consistent in all studies and therefore no direct comparison could be made between the papers. The first two studies were laboratory based and suggested that hybrid external fixation may have a benefit over internal fixation with respect to failure load and its use in compromised bone. Two further papers presented only type 4 evidence. The final paper was a multicentre randomised controlled trial and it demonstrated a marginal non-significant benefit of hybrid external fixation over internal fixation although there was suggestion of beta error [i.e. accepting the hypothesis when it is not true]. Conclusion  Bicondylar/Schatzker 6 type fractures are difficult to manage. The treatment of such fractures, need to pay specific attention to the soft tissue envelope around the knee. Hybrid external fixation has theoretical advantages in terms of the soft tissues but the benefit over internal fixation is modest at best and has not demonstrated improved outcome. Newer fixed angle screw and plate systems are increasingly in use and need comparative studies to determine their role in this complex group of fractures.     

Hybrid external fixation in periarticular tibial fractures. Good final outcome in 56 patients

Out of 65 patients with periarticular fractures of the tibia treated by use of hybrid external fixation (a combination of indigenously manufactured version of ring and AO tubular fixator) from February 1997 to October 2003, 56 cases were taken up for this study with a minimum follow-up of 12 months. The injury was due to a high-velocity motor vehicle accident in 49 and a fall in 7 patients. Thirty five were tibial plateau fractures and 21 were distal tibial plafond fractures. Forty eight were compound fractures and eight were closed. They were treated by debridement (48 compound) and hybrid external fixator (n = 56). All the patients were assessed clinically and radiographically for an average follow-up of 42.5 months (range: 12 to 67). In tibial plateau fractures (n = 35), the final outcome was good to excellent in 30, fair in 2 and poor in 3. In tibial plafond fractures (n = 21), results were good to excellent in 16, fair in 3 and poor in 2. We recommend the use of hybrid external fixator for periarticular tibial fractures occurring due to high-energy trauma. In addition, rates of complications as seen with other modalities of fixation are greatly reduced. It facilitates adequate care of associated soft tissue injuries.     

Bicondylar tibial plateau fractures treated with fine-wire circular external fixation

Bicondylar tibial plateau fractures are serious injuries to a major weight-bearing joint. These injuries are often associated with severe soft tissue injuries that complicate surgical management. We reviewed 54 consecutive patients who sustained bicondylar tibial plateau fractures that were treated with limited open reduction and cannulated screw fixation combined with fine-wire circular external fixation. Forty-six patients met the inclusion criteria of this retrospective review. Eight patients were excluded because they did not complete a minimum of 1-year follow-up. Thirty-six patients had Schatzker type-VI, and ten patients had Schatzker type-V fractures. All fractures were united without loss of reduction; there were no incidences of wound complications, osteomyelitis or septic arthritis. The average Knee Society Clinical Rating Score was 81.6, translating to good clinical results. Minor pin track infection was the most common complication encountered. This review concludes that fine-wire circular external fixation, combined with limited open reduction and cannulated screw fixation, consistently produces good functional results without serious complications.     

Arthroscopic-assisted reduction with bilateral buttress plate fixation of complex tibial plateau fractures

Purpose:Our aim was to determine the outcome of arthroscopic-assisted reduction with bilateral buttress plate fixation for the treatment of closed complex tibial plateau fractures.Type of Study:Case series.Methods:18 consecutive patients (12 men, 6 women) with complex tibial plateau fractures were enrolled in this prospective study. All patients underwent arthroscopic-assisted bilateral buttress plate fixation of closed complex tibial plateau fractures. The average age at operation was 35 years (range, 23 to 45 years). The follow-up period ranged from 39 to 69 months, with an average of 48 months. Using the Schatzker classification, there were 11 type V and 7 type VI fractures. The clinical and radiological outcomes were determined according to Rasmussen’s system.Results:All of the 18 fractures united. Overall, 4 (22%) patients were rated as excellent, 12 (67%) good, and 2 (11%) fair. Secondary osteoarthritis appeared in 3 injured knees (16.7%). One patient had a wound dehiscence (3 cm long) of the medial incision. Condylar joint surface depression was noted in 3 patients without functional instability. Two patients had valgus alignment between 10° and 15°. Two patients had the paresthesia over the lateral calf. There were no complications directly associated with arthroscopy in any of the 18 patients. No deep vein thrombosis, infection, or knee stiffness was found at final follow-up.Conclusions:Arthroscopic-assisted reduction with bilateral buttress plate fixation for complex tibial plateau fractures allows accurate fracture reduction, diagnosis, and treatment of associated intra-articular lesions, and less dissection than open reduction internal fixation.     

Management of distal tibial intra-articular fractures with circular external fixation

The treatment of tibial plafond fractures requires careful management of the soft tissue envelope, reconstruction of the articular surface and stable fixation with minimal additional damage. Thirty cases of AO type 43 C tibial fractures were treated by transosseous osteosynthesis (Ilizarov technique). The external fixator constructs used were Ilizarov (Transosseous osteosynthesis: theoretical and clinical aspects of the regeneration and growth of tissue, Springer, Berlin, 1992) and Sheffield (Classification AO des fractures, Springer, Berlin, 1987) circular fixator systems. All tibial plafond fractures healed. Using radiological criteria for assessment of reduction of the articular fragments and the clinical scoring system described by Teeny and Wiss, there were excellent and good restoration of articular structure in 27 cases and good clinical results in 14. This treatment method compares well with previous published series and is to be recommended for this group of difficult fractures.     

Outcomes of open bicondylar tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation

This study was conducted to evaluate the outcome of treatment for open fractures of the tibial plateau using external circular fixation combined with or without limited internal fixation. Twenty-five patients (16 males and 9 females) with open fracture tibial plateau were treated with circular external fixator with minimal internal fixation. The mean age of the patients was 36 years (range between 23 and 62 years). According to AO classification system, there was six (24 %) C1, eleven (44 %) C2, and eight (32 %) C3. According to Gustilo and Anderson classification, seven (28 %) were grade 1; nine (36 %), grade 2; six (24 %), grade 3b; and three (12 %), grade 3c. According to ASAMI score, Italy, the results were excellent in 8 (32 %) cases, good in 12 (48 %) cases, and fair in five (20 %) patients. The patients’ satisfaction was significantly related to the functional results (p < 0.05). Complications included skin gaping in one case 10 days postoperatively. Pin tract infection was seen in 20 % of cases, one case showed deep infection and no cases of septic arthritis. There is no correlation between the final outcome and articular depression (p > 0.05). Ilizarov external fixator provides acceptable outcomes but with a high rate of complication rate, typical of this type of fracture. It avoids extensive soft tissue dissection.     

Complex tibial plateau fractures treated with Ilizarov external fixator with or without minimal internal fixation

We treated 30 tibial plateau fractures (Schatzker Type VI) in 29 patients, with a mean age of 41.4 (20–76) years, with the Ilizarov fixator. In 18 fractures, we combined the treatment with minimal internal fixation. All fractures were the result of high-energy trauma, and 20 patients had associated injuries. Twenty-eight fractures were available for follow-up after 27 (16–36) months. Using The Knee Society clinical rating system, 18 knees were rated as excellent, seven as good, one as fair, and two as poor. There was a direct correlation between the presence of associated injuries and the final outcome. The most significant concomitant injuries were distal femoral fractures and extensive soft-tissue injury. This study emphasizes the clinical success and low morbidity associated with the use of external fixation and minimal internal fixation.

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Résumé Nous avons traité chirurgicalement 30 fractures du plateau tibial (Type Schatzker VI) chez 29 malades—âge moyen de 41,4 ans (20–76)—avec un fixateur dIlizarov. Pour 18 fractures nous avons combiné le traitement avec une fixation interne légère. Toutes les fractures étaient le résultat dun traumatisme à haute énergie et 20 patients avaient des lésions associées. Après un suivi de 27 mois (16–36) 28 fractures étaient étudiables. Avec le score de la Knee Society, 18 genoux ont été estimés comme excellents, sept comme bons, un comme moyen, et deux comme mauvais. Il y avait une corrélation directe entre la présence de blessures associées et le dernier résultat, le plus significatif étant lexistence dune fracture fémorale distale et limportance des lésions des parties molles. Létude met en relief le succès clinique et la basse morbidité associés à lusage du fixateur externe et de la fixation interne légère.

     

Intra-articular fractures of the tibial plafond. A comparison of the results using articulated and ring external fixators

We retrospectively reviewed 60 fractures of the tibial plafond treated by either an ankle-sparing diaphyseal-epiphyseal technique using the Ilizarov ring fixator or by an ankle-spanning technique using a monolateral articulated external fixator. The Ilizarov ring fixator was applied in 24 fractures and the monolateral articulated transarticular external fixator in 20. Both techniques were combined with limited open reduction and internal fixation of the articular surface if necessary. Between three and nine years after the injury, all patients returned for clinical and radiological assessment and evaluation of ankle function using the modified Mazur score. There were no significant differences between the two groups in terms of age, gender, mechanism of injury, type of fracture or length of follow-up. The mean functional ankle score was 86 points for the Ilizarov group and 82 points for the articulated fixator group. The difference was not significant (p = 0.07). There were no significant differences between the groups with regard to the radiographic score and late complications. Patients treated with the Ilizarov ring fixator had significantly better ankle and subtalar movement. We conclude that both techniques of external fixation are satisfactory methods of treatment for fractures of the tibial plafond, but that the total arc of movement of the joint is preserved better without bridging the ankle.     

Surgical Treatment of Tibial Plateau Fractures

Objective

Closed reduction of Schatzker type 4, 5, and 6 fractures of the tibial plateau, internal fixation by lag screws inserted through a mini-incision, and stabilization with Ilizarov external ring fixator.

Indications

Fractures of the tibial plateau of Schatzker type 4, 5, and 6.

Contraindications

Open infected tibial plateau fractures. Relative contraindications are Schatzker type 1, 2, and 3 fractures of the tibial plateau which can be treated by simpler methods.

Surgical Technique

Reduction of fracture by longitudinal traction on a frature table. Percutaneous insertion of two or three 6.5-mm lag screws to compress the major fragments. Stabilization of the fracture with a three-ring construction of the Ilizarov frame. Further compression of fragments with olive wires, used also to reduce and compress posterolateral and/or posteromedial fragments. The frame is ex-tended to the femur in instances of subluxation of the knee joint, ligamentous injuries, and associated femoral condylar fractures.

Results

Between 1991–1997, 56 patients were operated on. Aver-age follow-up: 3 years. Union occurred in all. Six patients showed a varus deformity of 5–10° and one a varus deformity of 15° four patients had an extension lag between 5–10°. A minor pin tract infection was observed 20 times and a major pin tract infection three times necessitating pin removal. One patient who suffered a compound fracture complicated by aseptic arthritis eventually required an arthrodesis. Applying the score of the American Knee Society, an excellent result was obtained 20 times, a good result 28 times, a fair one four times, and a poor one four times.     

苏氏正骨法与外固定结合治疗胫骨平台骨折

目的:比较苏氏正骨法结合外固定与内固定治疗胫骨平台的疗效。方法:本组240例胫骨平台骨折中男185例,女55例;年龄24~64岁,平均42岁。随机分为外固定组(A组)和内固定组(B组),每组120例,分别采用苏氏整复手法结合外固定器(A组)和切开复位钢板螺钉内固定(B组)治疗,比较两种疗法的疗效。结果:240例均获随访,随访时间6~20个月,平均12.4个月,按临床功能评分标准:A组优25例,良88例,可6例,差1例,优良率94.17%;B组优11例,良86例,可23例,差0例,优良率80.83%。两组疗效经秩和检验,差异有显著性意义(P<0.01)。结论:苏氏正骨法与外固定结合是治疗胫骨平台骨折的一种有效方法,但越膝外固定器限制膝关节活动,需进一步改进成带活动轴可屈曲式外固定器。     

关节镜辅助经皮内固定和切开复位内固定治疗Schatzker Ⅱ、Ⅲ型胫骨平台骨折的比较研究

目的比较关节镜辅助经皮内固定和切开复位内固定治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折的疗效。方法 2006年8月-2010年4月,收治58例SchatzkerⅡ、Ⅲ型胫骨平台闭合骨折患者,根据治疗方法不同随机分为两组,其中38例采用关节镜辅助经皮内固定治疗(关节镜组),20例采用切开复位内固定治疗(对照组)。两组患者性别、年龄、病程、骨折类型、合并症比较,差异均无统计学意义(P>0.05),具有可比性。记录两组手术时间、切口长度、骨折愈合时间、术后并发症发生情况;按美国特种外科医院(HSS)评分标准行膝关节功能评分,测量关节活动度。结果术后两组患者切口均Ⅰ期愈合。关节镜组手术时间较对照组长,切口较对照组短,差异均有统计学意义(P<0.05)。两组患者均获12～14个月随访。术后6个月关节镜组膝关节HSS评分优于对照组,关节活动度大于对照组,差异均有统计学意义(P<0.05)。X线片检查示两组骨折均达骨性愈合,关节镜组愈合时间较对照组短,但差异无统计学意义(t=2.14,P=0.41)。关节镜组2例(5.3%)术后1周出现关节晨僵;对照组6例(30.0%)术后1周出现关节疼痛,其中3例伴关节僵直;均经对症处理后症状缓解。两组并发症发生率比较,差异有统计学意义(χ2=6.743,P=0.016)。结论关节镜辅助经皮内固定治疗SchatzkerⅡ、Ⅲ型胫骨平台骨折与切开复位内固定相比,具有术后功能恢复快、并发症少等优点。