华西医学

华西医学

支撑钢板治疗 Schatzker 型胫骨平台骨折的临床效果

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目的探讨使用支撑钢板治疗 Schatzker Ⅳ型胫骨平台骨折的临床效果。 方法选择 2013 年 4 月—2014 年 9 月采用支撑钢板治疗 Schatzker Ⅳ型胫骨平台骨折患者。使用内侧切口或后内侧切口,必要时采用其他辅助切口,利用有限接触加压钢板、1/3 管型钢板或“T”型钢板固定支撑骨折。结果共纳入患者 14 例,男 6 例,女 8 例;年龄 20~52 岁,平均(35.2±9.8)岁。14 例患者均获得随访,随访时间 12~25 个月,平均(16.3±4.0)个月。术后 1 个月患者膝关节屈曲 80~130°,平均(97.9±13.1)°;术后 3 个月膝关节屈曲 90~140°,平均(119.3±12.1)°。术后 1 年膝关节美国特种外科医院膝关节临床功能评分 78~96 分,平均(88.4±4.9)分;末次随访时根据 Rasmussen 评分系统评定膝关节功能,优 8 例,良 4 例,可 2 例,优良率为 85.7%。术后无患者出现感染、骨不愈合、血管神经损伤、内固定失效等并发症。结论支撑钢板治疗 Schatzker Ⅳ 型胫骨平台骨折,既能有效达到维持复位,防止胫骨平台二期塌陷,又能保证膝关节对线对位良好,对血管神经等重要组织激惹少,手术并发症较少,膝关节功能较满意。

ObjectiveTo evaluate the clinical therapeutic effect of support plates on Schatzker type Ⅳ tibial plateau fractures.MethodsPatients with Schatzker type Ⅳ tibial plateau fractures underwent support plates treatment between April 2013 and September 2014 by using the medial incision or posterior medial incision, if necessary, with other auxiliary incisions, with limited contact compression plate, 1/3 tubular plate or " T” plate to support the fracture. ResultsA total of 14 patients including 6 males and 8 females with an average age of (35.2±9.8) years (ranged from 20 to 52 years) were enrolled in this study and followed up for 12–25 months with an average of (16.3±4.0) months. The knee joints were flexed 80–130° with an average of (97.9±13.1)° one month after the surgery and 90–140° with an average of (119.3±12.1)° three months after the surgery. One year postoperatively, the mean Hospital of Special Surgery knee score ranged from 78 to 96 with an average of 88.4±4.9. Last follow-up assessment of knee function according to Rasmussen scoring system showed excellent in 8 cases, good in 4 cases, and fair in 2 cases; the excellent and good rate was 85.7%. No postoperative complications such as infection, nonunion, vascular nerve injury, or internal fixation failure occurred. ConclusionThe support plates for the treatment of Schatzker type Ⅳ tibial plateau fractures can maintain good reduction, prevent the secondary collapse of the tibial plateau, ensure that knee joint has good alignment, less complications with vascular or nerve injuries, and finally get a satisfied function recovery.

关键词: 支撑钢板; 胫骨平台骨折; 临床效果

Key words: Support plates; Tibial plateau fracture; Clinical outcomes

引用本文: 邹昌, 方跃, 晏兆魁, 李东哲. 支撑钢板治疗 Schatzker 型胫骨平台骨折的临床效果 . 华西医学, 2018, 33(9): 1128-1133. doi: 10.7507/1002-0179.201808044 复制

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1. Yang G, Zhu Y, Luo C, et al. Morphological characteristics of Schatzker type Ⅳ tibial plateau fractures: a computer tomography based study. Int Orthop, 2012, 36(11): 2355-2360.
2. Rasmussen PS. Tibial condylar fractures. impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg Am, 1973, 55(7): 1331-1350.
3. Katsenis D, Dendrinos G, Kouris A, et al. Combination of fine wire fixation and limited internal fixation for high-energy tibial plateau fractures: functional results at minimum 5-year follow-up. J Orthop Trauma, 2009, 23(7): 493-501.
4. Haider SJ, Pean CA, Davidovitch RI, et al. Functional outcomes of isolated medial tibial plateau fractures. J Knee Surg, 2015, 29(5): 414-422.
5. Chang SM, Zhang YQ, Yao MW, et al. Schatzker type Ⅳ medial tibial plateau fractures: a computed tomography-based morphological subclassification. Orthopedics, 2014, 37(8): e699-e706.
6. Zhai Q, Hu C, Xu Y, et al. Morphologic study of posterior articular depression in SchatzkerⅣ fractures. Orthopedics, 2015, 38(2): e124-e128.
7. 罗从风, 陈云丰, 高洪, 等. 改良双钢板法治疗复杂胫骨平台骨折. 中华骨科杂志, 2004, 24(6): 326-329.
8. 陶杰, 杭栋华, 王秋根, 等. 改良侧后方入路治疗胫骨平台后方剪力骨折. 中国矫形外科杂志, 2008, 16(24): 1863-1866.
9. Hohl M. Tibial condylar fractures. J Bone Joint Surg Am, 1967, 49(7): 1455-1467.
10. Frosch KH, Balcarek P, Walde T, et al. A new posterolateral approach without fibula osteotomy for the treatment of tibial plateau fractures. J Orthop Trauma, 2010, 24(8): 515-520.
11. Qiu WJ, Zhan Y, Sun H, et al. A posterior reversed L-shaped approach for the tibial plateau fractures: a prospective study of complications (95 cases). Injury, 2015, 46(8): 1613-1618.
12. Molenaars RJ, Mellema JJ, Doornberg JN, et al. Tibial plateau fracture characteristics: computed tomography mapping of lateral, medial, and bicondylar fractures. J Bone Joint Surg Am, 2015, 97(18): 1512-1520.
13. Acklin YP, Potocnik P, Sommer C. Extended medial approach in posteromedial proximal tibia fracture dislocation. Oper Orthop Traumatol, 2015, 27(2): 183-190.
14. Luo CF, Sun H, Zhang B, et al. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma, 2010, 24(11): 683-692.
15. Dall’oca C, Maluta T, Lavini F, et al. Tibial plateau fractures: compared outcomes between ARIF and ORIF. Strategies Trauma Limb Reconstr, 2012, 7(3): 163-175.
16. 罗从风, 姜锐, 仲飙, 等. 经后侧入路支撑钢板固定治疗胫骨平台后侧劈裂骨折. 中华创伤骨科杂志, 2007, 9(1): 6-9.
17. Huang X, Zhi Z, Yu B, et al. Stress and stability of plate-screw fixation and screw fixation in the treatment of Schatzker type Ⅳ medial tibial plateau fracture: a comparative finite element study. J Orthop Surg Res, 2015, 10: 182.
18. Weaver MJ, Harris MB, Strom AC, et al. Fracture pattern and fixation type related to loss of reduction in bicondylar tibial plateau fractures. Injury, 2012, 43(6): 864-869.
19. Sciadini MF, Sims SH. Proximal tibial intra-articular osteotomy for treatment of complex schatzker type Ⅳ tibial plateau fractures with lateral joint line impaction: description of surgical technique and report of nine cases. J Orthop Trauma, 2013, 27(1): e18-e23.
20. Persiani P, Gurzì MD, Di Domenica M, et al. Risk analysis in tibial plateau fractures: association between severity, treatment and clinical outcome. Musculoskelet Surg, 2013, 97(2): 131-136.
21. Stannard JP, Lopez R, Volgas D. Soft tissue injury of the knee after tibial plateau fractures. J Knee Surg, 2010, 23(4): 187-192.
22. 罗从风, 陈健, 孙辉. 胫骨平台后柱骨折的手术治疗. 中华创伤骨科杂志, 2008, 10(9): 804-807.
23. 杨胜松, 王满宜, 荣国威. Schatzker Ⅳ 型胫骨平台骨折的分型及治疗. 中华外科杂志, 2004, 42(19): 1161-1164.
24. Jiang R, Luo CF, Zeng BF. Biomechanical evaluation of different fixation methods for fracture dislocation involving the proximal tibia. Clin Biomech (Bristol, Avon), 2008, 23(8): 1059-1064.
25. Zhang W, Luo CF, Putnis S, et al. Biomechanical analysis of four different fixations for the posterolateral shearing tibial plateau fracture. Knee, 2012, 19(2): 94-98.
26. 文浩, 段戡, 袁长深, 等. 锁定钢板与双钢板内固定治疗Schatzker Ⅳ~Ⅵ 型胫骨平台骨折的 Meta 分析. 中国矫形外科杂志, 2014, 22(20): 1842-1846.