解剖钢板和Liss钢板置入治疗复杂性胫骨平台骨折的疗效比较

目的：对比观察解剖钢板和Liss钢板治疗复杂性胫骨平台骨折的疗效。 方法：选择苏州大学附属第一医院骨科收治的复杂性胫骨平台骨折患者45例，男29例，女16例，年龄18~76岁，平均43.1岁。其中采用解剖钢板内固定治疗25例，Liss钢板内固定治疗20例。记录两组内固定时间、内固定过程中出血量、骨折愈合时间、完全负重时间及内固定取出时间，观察伤口愈合情况及有无并发症发生，Merchant标准评定膝关节功能变化。 结果：45例患者均获得随访，随访时间1~3年，骨折均达临床愈合，无骨不连发生。仅解剖钢板组2例出现局部皮肤感染、坏死，经换药、皮瓣移植后治愈；两组患者骨折愈合时间、负重时间、内固定取出时间相比，差异均无显著性意义(P > 0.05)。内固定置入后10~12个月，参照Merchant标准评定膝关节功能，解剖钢板组优18例，良3例，中2例，差2例，优良率84%；Liss钢板组优15例，良2例，中2例，差1例，优良率85%；两组膝关节功能相比，差异无显著性意义(P > 0.05)。解剖钢板组2例内固定松动，1例出现退钉，但无断裂；1例患者术后出现膝关节僵硬，1例出现膝关节创伤性关节炎。Liss钢板组1例出现膝关节创伤性关节炎。 结论：解剖钢板和Liss钢板治疗复杂性胫骨平台骨折的效果相当，对于胫骨平台骨折，应根据患者受伤情况、骨质条件、经济情况等选择固定材料。

Comparison of therapeutic effects of anatomic plate and Liss plate implantation for treating complex fractures of tibial plateau

OBJECTIVE: To compare therapeutic effects of anatomic plate and limited invasive stabilization system (Liss) in the treatment of complex fractures of tibial plateau. METHODS: A total of 45 cases of complex fractures of the tibial plateau were treated at the Department of Orthopaedics, First Affiliated Hospital, Soochow University, including 29 males and 16 females, aged 18-76 years, averagely 43.1 years. There were 25 cases undergoing anatomic plate and 20 cases undergoing Liss limited invasive stabilization system. Time of internal fixation, bleeding volume during internal fixation, time of fracture healing, complete loading time and time of internal fixation removal were recorded. Wound healing and complication were observed. Merchant criteria were used to evaluate knee joint function. RESULTS: All 45 patients were followed up for 1-3 years. Fracture healed with no occurrence of nonunion. Two cases in the anatomic plate presented partial skin infection and necrosis, and were cured through the dressing change and flap displacement. No significant difference was detected in the time of fracture healing, weight-bearing and plate removal (P > 0.05). At 10-12 months after operation, the knee function was assessed according to Merchant criteria. In the anatomic plate group, 18 cases were excellent, 3 good, 2 fair and 2 poor, resulting in excellent and good rate of 84%. In the limited invasive stabilization system group, 15 cases were excellent, 2 good, 2 fair and 1 poor, resulting in excellent and good rate of 85%. There was no significant difference in knee joint function between the two groups (P > 0.05). In the anatomic plate group, 2 cases developed loose of internal fixation, 1 case of nail withdraw, without breakage, 1 case of knee joint stiffness, 1 case of traumatic arthritis in the knee joint. In the limited invasive stabilization system group, 1 case affected traumatic arthritis in the knee joint. CONCLUSION: The therapeutic effects of anatomic plate and limited invasive stabilization system were similar in the treatment of complex tibial plateau fractures. Fixation materials should be selected according to the state of injury, bone conditions and economic status.