聯合入路手術治療SchatzkerⅤ、Ⅵ型脛骨平臺骨折的療效分析

江帝欽　溫干軍　蔡蕊　張史飛　陳堅　周國新　周樹根　周植森　滕范文

【摘要】 目的：采用前外側入路聯合后內側入路雙鋼板或者三鋼板治療Schatzker Ⅴ、Ⅵ型脛骨平臺骨折，探討其臨床療效。方法：選取Schatzker Ⅴ、Ⅵ型脛骨平臺骨折患者31例，均采用前外側入路聯合后內側入路，外側采用“L”型鎖定鋼板固定、內側用“T”型鎖定鋼板固定，必要時后側輔于重建鎖定鋼板固定。記錄測量患者術后即刻、6、12個月脛骨平臺內翻角（TPA）及后傾角（PA），X線片的骨折愈合時間，膝關節(jié)活動度，術后3、6、12個月采用HSS評定膝關節(jié)功能。結果：31例患者均獲得隨訪，時間9～24個月，平均（14.60±3.72）個月。骨折全部愈合，X線片愈合時間13～25周，平均（16.7±3.43）周；膝關節(jié)活動度100°～135°，平均（121.1±5.6）°。術后即刻、6、12個月TPA分別為（85.1±2.1）°、（84.6±1.4）°、（86.1±1.8）°；PA分別為（7.4±1.3）°、（7.3±1.8）°、（7.5±2.1）°；術后即刻、6、12個月的TPA、PA比較，差異均無統(tǒng)計學意義（P>0.05）。術后3、6、12個月HSS膝關節(jié)功能評分分別為（70.9±1.3）分、（75.1±1.8）分、（81.5±1.3）分，術后3、6、12個月HSS膝關節(jié)功能評分比較，差異均無統(tǒng)計學意義（P>0.05）。出現患肢關節(jié)僵硬2例，淺表感染1例，經使用抗生素后愈合，延遲愈合1例。本研究未出現血管、神經損傷和骨筋膜室綜合征。最后1次隨訪，骨折均骨性愈合，無膝關節(jié)內翻或外翻、膝關節(jié)不穩(wěn)、內固定松動或斷裂的病例。結論：對于Schatzker Ⅴ、Ⅵ型脛骨平臺骨折的治療，前外側入路聯合后內側入路雙鋼板或三鋼板固定是有效和可靠的，具有顯露充分、直視精準復位、便于操作、固定牢固、并發(fā)癥較少等特點，并且能早期進行功能鍛煉，臨床療效滿意。

【關鍵詞】 脛骨平臺骨折； 前外側入路； 后內側入路

Curative Effect Analysis of Combined Approach in Treatment of Schatzker Ⅴ and Ⅵ Tibial Plateau Fractures/JIANG Diqin，WEN Ganjun，CAI Rui，et al.//Medical Innovation of China，2017，14（32）：041-046

【Abstract】 Objective：To investigate the clinical efficacy of anterolateral approach combined with posteromedial approach，double plate or three plate in treatment of Schatzker Ⅴ and Ⅵ tibial plateau fractures.Method：31 cases of tibial plateau fractures of Schatzker Ⅴ and Ⅵ were selected，they were treated with anterolateral approach combined with posteromedial approach，outboard used of “L” type locking plate fixation，inboard used of “T” type locking plate fixation，if necessary，the rear side was assisted by reconstruction locking plate fixation.The tibial plateau varus angle（TPA） and posterior tilt angle（PA） were measured after operation immediately，6 and 12 months，X-ray of fracture healing time，knee joint range of motion，and knee function was evaluated by HSS at 3，6 and 12 months after operation.Result：31 patients were followed up for 9-24 months，average of（14.6±3.72） months，all fractures healed，X-ray healing time was 13-25 weeks，average of（16.7±3.43） weeks，the knee joint 100-135 degrees，average of（121.1±5.6） degrees.After operation Immediately，6 and 12 months，TPA were（85.1±2.1） degrees，（84.6±1.4） degrees and（86.1±1.8） degrees respectively，PA were were（7.4±1.3） degrees，（7.3±1.8） degrees and（7.5±2.1） degrees respectively，TPA and PA at after operation immediately，6 and 12 months were compared，the differences were not statistically significant（P>0.05）.After operation 3，6 and 12 months，the scores of HSS knee function were（70.9±1.3） points，（75.1±1.8） points and（81.5±1.3） points respectively，the scores of HSS knee function were compared at after operation 3，6 and 12 months，the differences were not statistically significant（P>0.05）.There were 2 cases of joint stiffness，1 case of superficial infection occurred and healed after antibiotic treatment，1 case of delayed union.No vascular or nerve injury and compartment syndrome were found.The last follow-up，fracture were bone healing，no knee varus or valgus，knee instability， internal fixation loosening or rupture cases.Conclusion：For the treatment of Schatzker Ⅴ and Ⅵ tibial plateau fractures，anterolateral approach combined with posteromedial approach with double plate or three plate fixation is effective and reliable，has the advantages of sufficient exposure，accurate reset， convenient operation， firm fixation，less complications et al，and can perform early functional exercise，and the clinical curative effect is satisfactory.endprint

【Key words】 Tibial plateau fracture； Anterolateral approach； Posterior medial approach

First-authors address：Changping Hospital of Dongguan City，Dongguan 523573，China

doi：10.3969/j.issn.1674-4985.2017.32.010

脛骨平臺骨折是最常見的關節(jié)內骨折之一，約占所有骨折的1%，而內、外側平臺同時骨折占10%～30%。Scha……