前外侧单切口三钢板固定治疗胫骨平台三柱骨折的临床观察

目的 探讨前外侧单切口三钢板固定治疗胫骨平台三柱骨折的临床效果和应用价值。方法 选择2010年1月至2017年2月收治胫骨平台三柱骨折病人46例。按随机数字法分为观察组和对照组，每组23例。观察组采用前外侧单切口三钢板固定治疗方案；对照组采用前外侧切口联合后内侧倒L型双切口三钢板固定治疗方案。术后2组治疗要求等同，定期进行临床及影像学检查，并采用Rasmussen放射学评分及美国特种外科医院（HSS）评分进行膝关节功能评估。结果 46例均获得随访，随访时限18~24个月。观察组手术时间、术中出血量、术后引流量均明显少于对照组（P < 0.01），但2组骨折愈合时间比较差异无统计学意义（P>0.05）；术前、术后2组内翻角、后倾角测量值差异均无统计学意义（P>0.05），术后2组内翻角、后倾角测量值均明显小于术前（P < 0.01）。2组术后6个月及18个月Rasmussen放射学评分及HSS膝关节功能评分比较差异均无统计学意义（P>0.05），2组治疗前后比较差异亦均无统计学意义（P>0.05）。2组术后感染率差异均无统计学意义（P>0.05）。结论 前外侧单切口三钢板固定治疗相对于前外侧切口联合后内侧倒L型双切口三钢板固定治疗胫骨平台三柱骨折，在恢复关节面的平整及力学稳定性、膝关节功能方面无明显差异性。前外侧单切口三钢板固定方案比前外侧切口联合后内侧倒L型双切口入路复位三钢板固定治疗方案具有一定优势:术中操作简便，创伤小，手术时间短，出血少；前外侧单切口术后换药方便，不增加感染风险，值得临床推广。

Clinical observation of three-plate fixation with anterolateral single incision in the treatment of three-column fractures of tibial plateau

ObjectiveTo investigate the clinical effects and application value of three plate-fixation with anterolateral single incision in the treatment of three-column fractures of tibial plateau.MethodsForty-six patients with three-column fractures of tibial plateau from January 2010 to February 2017 were divided into the observation group and control group according to the random number method(23 cases in each group).The observation group was treated with three-plate fixation with anterolateral single incision, and the control group was treated with anterolateral incision combined with retromedial inverted L-shape double incision and three-plate fixation.The postoperative treatment in two groups were the same, the clinical and imaging examinations were conducted regularly, and the knee joint function was evaluated using Rasmussen radiological score and American hospital for special surgery(HSS) score.ResultsAll cases were followed up for 18-24 months.The operation time, intraoperative blood loss and postoperative drainage volume in observation group were significantly less than those in control group(P < 0.01), and there was no statistical difference in the healing time of fracture between two groups(P>0.05).There was no statistical significance in values of varus angle and rake angle between two groups before and after surgery(P>0.05), while the values of varus angle and rake angle in two groups after operation were significantly less than those before operation(P < 0.01).There was no statistical significance in Rasmussen radiology score and HSS knee function score between two groups after 6 and 18 months of operation, and the difference of which in two groups between before and after treatment was not statistically significant(P>0.05).The different of the infection rate in two group was not statistically significant(P>0.05).ConclusionsCompared with the anterolateral incision combined with retromedial inverted L-shape three-plate fixation, the three-plate fixation with anterolateral single incision in treating the tibial plateau three-column fractures can restore the joint surface smooth and mechanical stability, and there is no significant difference in the function of knee joint between two groups.The three-plate fixation with anterolateral single incision in treating the tibial plateau three-column fractures is better than that of the anterolateral incision combined with retromedial inverted L-shape three-plate fixation, which has the advantages of simple operation, less trauma, shorter operation time, less bleeding and ease to change medicine, and can obviously reduce the risk of infection, so it is worthful of popularization in clinic.