三柱理论在胫骨平台骨折治疗中的应用

目的：依据三柱理论指导胫骨平台骨折手术治疗,并评价其疗效。方法25例胫骨平台骨折患者,根据三柱理论分为12例单柱骨折、11例双柱骨折和2例三柱骨折。根据三柱理论选择手术入路和内固定方式,术后随访评价临床疗效。结果单柱、双柱和三柱骨折的平均手术时间分别为102．32、123．73和150．27 min,平均随访时间为15．22个月,平均愈合时间为13．50周,平均完全负重时间为14．20周。25例患者术后12个月HSS平均评分为86．85分；膝关节活动度2．20°~122．50°,患者术后与12个月后的胫骨平台内翻角、后倾角差异无统计学意义(P>0．05)。结论三柱理论能较好地提高临床医师对胫骨平台骨折的认识,有效指导手术入路与内固定的选择,显著提高胫骨平台骨折的手术疗效。

Application of three-column classification in tibial plateau fracture

Objective To guide tibial plateau fracture surgery based on the three-column classification and to evaluate its clinical value. Methods From April 2012 to May 2013, a CT-based three dimensional classification, three-column classification, was used for de-termining the category and surgery approach in 25 cases of tibial plateau fracture. According to the three-column classification, there were 12 one-column fractures, 11 double-column fractures and 2 three-column fractures. Results The surgery of one-column, double-column and three-column fractures averagely need 102. 32, 123. 73, 150. 27 mines, respectively. All the cases were followed up for a mean time of 15. 22 months with an average radiographic bone union time of 13. 50 weeks. The mean full weight-bearing time was 14. 20 weeks. The mean HSS score at 12 months postoperatively was 86. 85. The range of motion of the affected knee joints was 2. 20° to 122. 50°. There were no sig-nificant differences between immediate post~operation and 12 months in both tibial plateau angle and posterior slope angle(P>0. 05). Con-clusion The three-column classification can guide clinicians to have a general and three-dimensional cognition, and help to choose surgery approach and fixation. As a result, it can improve the surgical outcomes of tibial plateau fractures.