双切口入路治疗复杂胫骨平台骨折的疗效

目的：评价双切口入路治疗复杂胫骨平台骨折手术治疗方法及疗效。方法：2008年5月至2009年11月，手术治疗复杂胫骨平台骨折22例，其中男15例，女7例。年龄19～67岁，平均41．6岁。左侧10肢，右侧13肢，1例为双侧，均为闭合性骨折。致伤原因：高处坠落伤9例，交通伤11例，其他2例。按照Schatzker分型标准：Ⅴ型13肢，Ⅵ型10肢。受伤至手术时间5-14d，平均9．4d，均采用双切口入路，双钢板固定手术治疗。结果：所有患者均获随访12～22个月，平均14．6个月。术后骨折愈合时间6～9个月，平均7．4个月。其中1肢因关节面粉碎严重未达到解剖复位；1肢因干骺端粉碎严重未恢复下肢正常力线，出现膝内翻；2肢出现伤口表皮坏死，无骨外露，经换药处理后愈合。膝关节功能按Rasmussen评分标准评定：优10肢，良8肢，可2肢，差3肢。结论：双切口入路降低了软组织的并发症，有利于关节面复位：双钢板固定可靠，可早期行功能锻炼，是一种较好的治疗复杂胫骨平台骨折的手术入路和方法。

Treatment Effect of Complex Tibial Plateau Fracture Through Double-incision

Objective： To evaluate the surgical treatment and its results of complex tibial plateau fractures. Methods： From May 2008 to November 2009, 22 cases of complex tibial plateau fractures were treated by two-incision approaches. There were 15 male （including 1 case of bilateral fractures） and 7 female, with mean age of 41.6 years （19-67 years）, 10 fractures occurred in left extremity and 13 in the right. No patients suffered from open fracture. Fracture caused by fall from height in 9 cases, by traffic accident in 11 cases and by another causes in 2 cases. According to Schatzker classification, type Ⅴ fracture was found in 13 extremities and type Ⅵ in 10 extremities. All cases were operated with two-incision approaches and double-plates fixation. The operation was performed 5-14 days after injury with mean 9.4 days. Results： All cases were followed up from 12 to 22 months （mean 14.6 months）. Time of the bone healing was 6-9 months, with mean 7.4 months. No reduction of anatomy was achieved because of comminuted fractures of articular surfaces in 1 limb. The line of the lower extrimities did not recoved because of metaphysis comminution in 1 limb, which led to knee varus. Epidermal necrolysis was observed in 2 limbs, and the wound healed after change dressing. The function of the knee was evaluated according to Rasmussen＇s criteria, the results were excellent in 10 limbs, good in 8 limbs, fair in 2 limbs, and poor in 3 limbs. Conclusion： The two-incision approaches can reduce the complications of soft-tissue injury, which is conductive to reduction of articular surface. Double-plates provide a sufficient internal fixation, it can permit early motion of knee joint. Therefore, two-incision approache is an effective surgical approach for treatment of complex tibial plateau fractures.