Zhang Yong, Fan De-gang, Ma Bao-an, Sun Si-guo
Department of Orthopaedic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi Province, PR China.
Orthopedics. 2012 Mar 7;35(3):e359-64. doi: 10.3928/01477447-20120222-27.
The operative treatment of complicated bicondylar fractures of the tibial plateau remains a challenge to most surgeons. This retrospective study was designed to evaluate the clinical and radiological outcomes of dual plating via a 2-incision technique for the repair of complicated bicondylar tibial plateau fractures. A series of consecutive patients with bicondylar tibial plateau fractures treated by open reduction and internal fixation with a double buttress plate or a combination of locking plate and buttress plate via a 2-incision technique between March 2004 and March 2008 were retrospectively analyzed. Radiological and clinical results and complications of the 2 different fixation methods were compared. Seventy-nine patients matching the criteria of this study were followed up for at least 24 months. All of the fractures healed, with 3 cases of deep infection, 7 cases of secondary loss of reduction, 3 cases of secondary loss of alignment, and 10 cases of knee instability. At 24-month follow-up, mean Hospital for Special Surgery scores were 77.8±9.4 and 79.0±7.9 in the double buttress plate group and combination group, respectively. No significant differences in clinical or radiographic outcomes were found between the 2 groups, except that the combination group needed less bone graft. Dual plating with 2 incisions provided good exposition for the reduction and fixation of complicated bicondylar tibial plateau fractures. Using a combination of locking plate and buttress plate reduced the amount of bone graft compared with the double buttress plate technique.
胫骨平台复杂双髁骨折的手术治疗对大多数外科医生来说仍是一项挑战。本回顾性研究旨在评估经双切口技术采用双钢板固定修复复杂胫骨平台双髁骨折的临床和影像学结果。对2004年3月至2008年3月期间采用双切口技术通过切开复位并用双支撑钢板或锁定钢板与支撑钢板联合进行内固定治疗的一系列连续性胫骨平台双髁骨折患者进行回顾性分析。比较两种不同固定方法的影像学和临床结果及并发症。79例符合本研究标准的患者接受了至少24个月的随访。所有骨折均愈合，发生3例深部感染、7例复位二次丢失、3例对线二次丢失和10例膝关节不稳。在24个月随访时，双支撑钢板组和联合组的特种外科医院平均评分分别为77.8±9.4和79.0±7.9。两组之间在临床或影像学结果上未发现显著差异，只是联合组所需骨移植较少。双切口双钢板固定为复杂胫骨平台双髁骨折的复位和固定提供了良好的术野显露。与双支撑钢板技术相比，采用锁定钢板与支撑钢板联合减少了骨移植量。
