膝前后联合入路钢板置入固定修复Schatzker Ⅴ及Ⅵ型胫骨平台骨折

背景：Schatzker Ⅴ及Ⅵ 型胫骨平台骨折后常伴严重的关节面塌陷、胫骨髁分离、软组织及周围血管损伤。为减少软组织损伤，临床上一般采用有限切开复位、螺钉克氏针内固定外加跨关节外固定架固定的生物学固定方法进行修复，但对关节面复位不够充分。 目的：探讨膝关节内侧或后内侧与前外侧联合入路，置入内固定材料钛合金锁定加压钢板治疗Schatzker Ⅴ及Ⅵ 型胫骨平台骨折后的生物相容性效果。 方法：回顾性分析SchatzkerⅤ及Ⅵ 型胫骨平台骨折 50 例，采用膝前后联合入路锁定加钢板固定修复，观察患者的修复效果。 结果与结论：经钢板置入固定后，50例患者骨折均临床愈合，无骨不连、内固定松动断裂等并发症发生。骨折解剖位置平均Rasmussen评分为(14.3±1.9)分，优良率 90%；膝关节功能平均分为(24.3±2.5)分，优良率84%。固定后1年膝关节屈曲100°-130°，平均115°。结果证实，膝前后联合入路钢板置入修复 SchatzkerⅤ及Ⅵ 型胫骨平台骨折，具有修复后骨稳定性好，骨折复位及功能恢复好等钢板与宿主生物相容性好的特点。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程 

Anterior and posterior approaches of plate fixation for repair of Schatzker V and VI tibial plateau fractures

BACKGROUND:Schatzker V and VI tibial plateau fractures are often accompanied by severe articular facet collapse, separation of tibial condyles, damage of soft tissue and peripheral blood vessels. To reduce soft tissue damage, clinical treatments include limited open and reduction, Kirschner wire internal fixation and external fixation, however, these treatments are ineffective for the reduction of articular facet. OBJECTIVE:To evaluate the biocompatibility of titanium alloy locking compression plate fixation through the medial or posteromedial combined anterolateral approaches for treatment of Schatzker V and VI tibial plateau fractures. METHODS:Fifty patients of Schatzker V and VI tibial plateau fractures recruited from our hospital were analyzed retrospectively, and were treated with locking plate fixation through the combined approaches. The repair effect in patients was observed. RESULTS AND CONCLUSION:After plate fixation, the fractures in 50 patients were clinically healed, no cases appeared nonunion, loosening or breakage. According to the Rasmussen Rating, anatomical location average score was (14.3±1.9) points, with the good rate of 90%; average score of knee function was (24.3±2.5) points, with the good rate of 84%. At 1 year post-surgery, knee flexion range was 100°-130°, average 115°. Experimental findings indicate that, the plate fixation through the combined approaches can achieve good stability, good fracture reduction, and good functional recovery in treatment of Schatzker V and VI tibial plateau fractures.