三柱固定治疗复杂胫骨平台骨折的近远期疗效

目的探讨复杂胫骨平台骨折采用三柱固定的近远期疗效。方法 2011年1月—2015年1月,四川省攀枝花市中心医院骨科采用三柱固定理念共治疗24例闭合性复杂胫骨平台骨折。男性15例,女性9例;年龄20~58岁,平均42.4岁;采用Schatzker分型:V型8例,VI型16例;三柱分型:均涉及三柱。受伤至手术的平均时间8.5d。影像学评价采用测量术后即刻,1、3、6、12、24个月的力学指标,并进行动态比较,近远期疗效评价采用美国特种外科医院膝关节评分(hospital for special surgery knee score,HSS评分)评价术后1、3、6、12、24个月的功能得分,并进行动态比较。结果术后即刻,1、3、6、12、24个月的力学指标差异无统计学意义,而术后HSS评分系统中,方差分析示除屈曲畸形无统计学意义,其余疼痛、功能、活动范围、肌力以及关节稳定性差异均有统计学意义,术后1个月疗效最差,随着康复训练的加强,术后24个月疗效达到最佳。结论高能量胫骨平台骨折术后短期疗效并不理想,需要医护人员制定详细的康复训练计划和密切的电话随访,才能保证患者术后取得满意的远期疗效。

The short term and long term effects of the complex tibial plateau fractures treated with three-column fixation

Objective To explore the short term and long term effectiveness of complex tibial plateau frac-tures treated with three-column fixation.Methods From Jan.2011 to Jan.2015,24 closed complex tibial plateau fractures were treated using the three-column fixation concept in orthopedic department,Panzhihua Central Hospital of Sichuan province.There were 15 males and 9 females,and their age was from 20 to 58 years with an average of 42.4 years.According to Schatzker classification of the tibial plateau fractures,there were 8 cases of type V and 16 cases of type VI.According to three-column classification,all the cases were three-column fractures.The mean in-terval time from injury to operation was 8.5d.Radiologic results were evaluated by mechanical indexes immediately after operation,1-month,3-month,6-month,12-month 24-month postoperatively.The short term and long term effec-tiveness were estimated by hospital for special surgery knee score(HSS)at 1-month,3-month,6-month,12-month and 24-month postoperatively.Results No significant difference was found in mechanical indexes among immedi-ately after surgery,1-month,3-month,6-month,12-month and 24-month post-operative measurements.However, there were significant differences concerning pain,function,range of motion,muscle strength and joint stability,ex-cept for flexion deformity.The therapeutic effects were worst at the first month postoperatively,with the increase of rehabilitation training,the best therapeutic effects were achieved at twenty-fourth months postoperatively.Conclu-sion The short-term therapeutic effects are not ideal for patients associated with high energy tibial plateau frac -tures.To make these patients achieve satisfactory long-term effect,it is very important that medical personnel pro-vide detailed rehabilitation training plan and close telephone follow-up.