选择性内侧辅助固定结合微创内固定系统治疗复杂胫骨平台骨折

目的 探讨选择性内侧辅助固定结合微创内固定系统（LISS）治疗复杂胫骨平台骨折的临床效果。方法我院采用LISS治疗复杂胫骨平台骨折26例，男15例，女11例；按AO分型，均为AO41C型；按Schatzker分型，Ⅴ型16例，Ⅵ型10例。其中选择性双侧固定4例（15％），SchatzkerV型1例，SchatzkerⅥ型3例，内侧采用有限接触加压钢板（LC—DCP）辅助固定。结果患者平均随访14．8个月（12—22个月），术后即刻和术后1年胫骨平台内翻角（TPA）与胫骨平台后倾角（PA）比较差异均无统计学意义（P〉0．05），术后1年膝关节HSS评分，平均89．4分（73～98分）；术后复位不良1例（4％），术后1年未见骨折移位病例。本组病例无深部感染、骨折不愈合和内固定松动。结论LISS治疗复杂胫骨平台骨折，临床效果满意，并发症少，而针对小部分胫骨平台内侧柱严重粉碎骨折的病例，选择性内侧辅助固定，既可提高复位质量又可有效减少骨折二期移位。

Selective supplementary medial buttress plating combined with less invasive stabilization system in the treatment of complex tibial plateau fractures

Objective To prospectively summarize the clinical efficacy of selective supplementary medial buttress plating combined with less invasive stabilization system （LISS） in the treatment of complex tibial plateau fractures. Methods 26 cases of comminuted,unstable tibial plateau fracture were treated with LISS,including 15 males and 11 females（ age range 31 - 74yr, mean age 49.8yr）. According to the Schatzker typing, there were 16 cases of typeV and 10 cases of typeVI, while all the cases in the study could be classified as AO41C. 4 cases（ 1 cases of type V and 3 cases of type Ⅵ ） were selectively fixed with additional medial fixator-LC-DCP. Results The mean time of follow up in all the patients was 14.8 months （12 - 22 months）. The mean HSS score was 89.4 points （73 -98 points） and the mean value of tibial plateau angle（TPA） and tibial plateau posterior slope angle （PA） had no significant difference one year after operation （TPA： t = 1. 536, P = 0. 128; PA： t = - 1. 183, P = 0. 240 ）. The postoperative malreduction were 1 cases （4%） respectively. There was no second loss of reduction, deep infection or other soft tissue complications in all cases. The internal fixators were stable. Conclusion The satisfactory reduction and stable fixation can be achieved by LISS, especially by selectively combining with a medial buttress plate. Supplementary medial buttress plate is effective for comminution of medial column in complex tibial plateau fracture.