外侧锁定联合内侧支持钢板与双支持钢板内固定修复胫骨平台骨折的比较

背景：胫骨平台骨折采用单侧支持钢板容易形成偏心支撑，易导致成角畸形，而若仅用外侧支持钢板又容易出现膝关节内翻畸形。目的：比较双切口外侧锁定钢板联合内侧支持钢板与双支持钢板内固定修复复杂胫骨平台骨折的临床及影像学效果。方法：回顾性分析2009年3月至2013年11月收治86例复杂胫骨平台骨折患者的临床资料。根据其内固定方式分为2组，外锁定内支持组采用外侧锁定钢板固定骨折情况相对较复杂及粉碎程度较重的外侧，内侧采用支撑钢板；内外支持组则内外侧均采用支撑钢板固定。术后随访2年，对比两种内固定方式的临床及影像学效果。结果与结论：所有随访患者创口均Ⅰ期愈合，骨折均获得骨性愈合。两组患者的手术时间、上止血带时间及术中出血量比较差异均无显著性意义（P〉0.05）。术后随访发现，除完全负重时间外锁定内支持组明显早于双支持钢板组外（P〈0.05），两组骨折愈合时间、膝关节功能评分、膝关节活动度、术后胫骨平台内翻角、胫骨平台后倾及术后1年胫骨平台内翻角、胫骨平台后倾差异均无显著性意义（P〉0.05）。提示双切口双钢板置入内固定修复胫骨平台骨折具有良好的临床及影像学效果，与双支持钢板相比，外侧锁定钢板联合内侧支持钢板在完全负重时间上更具优势。

Lateral locking combined with medial support plate versus double support plate for repair of tibial plateau fractures

BACKGROUND：Unilateral support plate in the treatment of complex tibial plateau fractures easily formed eccentrical y brace, and easily led to angular deformity. The outer support plate alone is prone to knee varus deformity. OBJECTIVE：To compare the clinical and imaging effects with the outer locking plate combined with inner support plate fixation and double support plate using dual lateral incision in the repair of complex tibial plateau fracture. METHODS：We retrospectively analyzed the clinical data of 86 patients with complex tibial plateau fractures from March 2009 to November 2013. According to the different fixations, patients were divided into two groups. Outer locking plate combined with inner support plate group：lateral locking plate fixation for complex and comminuted fractures, and support plate was used in the inner side. Double support plate group used internal and external support plates. Patients were fol owed up for 2 years after the surgery. Clinical and imaging effects of two different fixations were compared. RESULTS AND CONCLUSION：Wounds were stage I healing in al the fol ow-up patients. Bone healing was conducted. No significant difference in operation time, time of tourniquet and intraoperative blood loss was detectable between both groups （P〉0.05）. Postoperative fol ow-up demonstrated that ful load time was significantly earlier in the outer locking plate combined with inner support plate group than in the double support plate group （P〈0.05）. No significant difference in fracture healing time, hospital for special surgery score, range of knee motion and postoperative tibial plateau angle, posterior slope angle and postoperative 1 year tibial plateau angle, posterior slope angle was detected between the two groups （P〉0.05）. These data confirmed that dual lateral incision double plate fixation in the repair of tibial plateau fractures had wel clinical and imaging features. Compared with the double support plates, outer locking plate combined with inner support p