Sament Radheshyam, Mayanger J C, Tripathy Sujit Kumar, Sen Ramesh Kumar
Department of Orthopaedics and Rehabilitation, JLN Medical College, Ajmer, India.
J Orthop Surg (Hong Kong). 2012 Apr;20(1):37-41. doi: 10.1177/230949901202000108.
To evaluate treatment outcomes of closed reduction and percutaneous screw fixation for tibial plateau fractures.
48 men and 8 women aged 19 to 61 (mean, 36) years underwent closed reduction and percutaneous screw fixation for closed tibial plateau fractures with <5 mm depression. According to the Schatzker classification, patients were classified into type I (n=9), type II (n=22), type IV (n=5), and type V (n=20). Closed reduction was achieved using manual ligamentotaxis with traction in extension under image intensifier control. Reduction was fixed percutaneously with cancellous screws (6.5 mm) and washers. Functional outcome (pain, walking capacity, extension lag, range of motion, and stability) was evaluated using the Rasmussen score. A total score of 28 to 36 was considered as excellent, 20 to 27 as good, 10 to 20 as fair, and <10 as poor.
Patients were followed up for a mean of 2.8 (range, 1-4) years. The mean length of hospital stay was 5 (range, 2-15) days. All the fracture united radiographically after a mean of 3 (range, 2.5-4.2) months. Respectively in Schatzker types-I, -II, -IV, and -V fractures, outcomes were excellent in 6, 10, 2, and 2 patients, good in 2, 9, 3, and 14 patients, fair in 1, 3, 0, and 2 patients, and poor in 0, 0, 0, and 2 patients. Outcome was satisfactory (good-to-excellent) in 89%, 86%, 100%, and 80% of the respective fracture types of patients. The mean Rasmussen score was 25.7 for all patients; it was 27.7 for type I, 26.3 for type II, 28.6 for type IV, and 23.4 for type V fractures. The mean Rasmussen score was significantly lower in 12 patients with ligament injury than in 44 patients without ligament injury (19.8 vs. 27.3, p<0.001). No patient had any complication (infection, wound dehiscence or hardware problem).
Closed reduction and percutaneous screw fixation for tibial plateau fractures is minimally invasive. It reduces the length of hospital stay and costs, enables early mobilisation with minimal instrumentation, and achieves satisfactory outcomes.
评估闭合复位经皮螺钉固定治疗胫骨平台骨折的疗效。
48例男性和8例女性，年龄19至61岁（平均36岁），因闭合性胫骨平台骨折凹陷<5mm接受闭合复位经皮螺钉固定治疗。根据Schatzker分类，患者分为I型（n = 9）、II型（n = 22）、IV型（n = 5）和V型（n = 20）。在影像增强器控制下，通过手动韧带牵引法在伸直位牵引实现闭合复位。用松质骨螺钉（6.5mm）和垫圈经皮固定复位。使用Rasmussen评分评估功能结果（疼痛、行走能力、伸直滞后、活动范围和稳定性）。总分28至36分为优，20至27分为良，10至20分为可，<10分为差。
患者平均随访2.8年（范围1 - 4年）。平均住院时间为5天（范围2 - 15天）。所有骨折在平均3个月（范围2.5 - 4.2个月）后经X线检查愈合。在Schatzker I型、II型、IV型和V型骨折中，分别有6例、10例、2例和2例患者结果为优，2例、9例、3例和14例患者结果为良，1例、3例、0例和2例患者结果为可，0例、0例、0例和2例患者结果为差。各骨折类型患者中，89%、86%、100%和80%的结果为满意（良至优）。所有患者的平均Rasmussen评分为25.7；I型骨折为27.7，II型骨折为26.3，IV型骨折为28.6，V型骨折为23.4。12例韧带损伤患者的平均Rasmussen评分显著低于44例无韧带损伤患者（19.8对27.3，p<0.001）。无患者出现任何并发症（感染、伤口裂开或内固定问题）。
闭合复位经皮螺钉固定治疗胫骨平台骨折具有微创性。它缩短了住院时间和费用，可在器械使用最少的情况下早期活动，并取得满意的结果。
