双钢板内固定结合植骨治疗高能量胫骨平台骨折

目的探讨双钢板结合植骨治疗高能量胫骨平台骨折的临床疗效。方法 2008年10月～2011年10月,应用双钢板内固定结合植骨术治疗高能量胫骨平台骨折患者,其中Ⅴ型骨折15例,Ⅵ型骨折10例。结果本组患者均获随访,随访时间6～36个月,平均(16.50±1.35)个月。随访期内无明显关节面再次塌陷及力线的丢失。术后3个月根据X线片测量胫骨股胫角平均为(175.00±2.39)°,胫骨平台内翻角平均(84.00±3.76)°,后倾角平均为(7.00±2.47)°。终末随访从膝关节活动范围、行走步态、疼痛程度评价,术后1年膝关节HSS评分平均(86.40±2.27)分(64～97分),其中优12例,良9例,可4例,优良率(91.04±3.36)%。无膝内、外翻畸形,无钢板、螺钉断裂,无深部感染及内外固定失败。结论采用双钢板内固定结合植骨能为高能量胫骨平台骨折提供良好的力学稳定性,降低并发症的发生率,获得理想的膝关节活动度。

Treatment for high-energy fractures of tibial plateau using double steel plates internal fixation and bone grafting

Objective To investigate the treatment for high-energy fractures of tibial plateau using double steel plates internal fixation and bone grafting.Methods 25 patients,which include 15cases of type Ⅴ and 10 of type Ⅵ,who suffered high-energy fractures of tibial plateau were admitted into author's hospital between October 2008 to October 2010.All of them treated by double steel plates internal fixation and bone grafting.Results The average follow-up period was(16.50±1.35) months(6-36months).No obvious articular surface subsidence and the force line lost again in all cases.The cohort had a mean 3 months postoperative femorotibial angle of(175.00±2.39)°,a mean 3 mons postoperative tibial plateau angle of(84.00±3.76)° and a mean 3 mons postoperative posterior slope angle of(7.00±2.47)°.The excellent and good rate was(91.04±3.36)%,no inversion or eversion of the knee occurred,and no breakage of screw and plate experienced,and no deep infection happened.Conclusion Double steel plate's internal fixation and bone grafting in the treatment of high-energy fractures of tibial plateau can obtain excellent biomechanical stability,lower complication rate and better range of motion of knee.