Xu Yun-Qin, Li Qiang, Shen Tu-Gang, Su Pei-Hua, Wang Gang, Yao You-Rong, Deng Pan, Luo Zheng-Li, Wei Qiang-Qiang, Tang Yong
The Forth Department of Orthopaedics, the 98th Hospital of PLA, Huzhou 313000, Zhejiang, China.
Zhongguo Gu Shang. 2013 Jan;26(1):65-70.
To explore optimal choice of surgical treatment and operative approach for closed complex tibial plateau fractures and its influencing factors.
From January 2003 to January 2011, 95 patients with closed complex tibial plateau fractures were estimated Schatzker V and Vl, and treated with three different surgical methods. The methods included single plate through anterolateral incision (Group A, 22 cases), double plates through inside and outside incisions (Group B, 36 cases), and double plates through antero-midline incisions (Group C, 37 cases). There were 56 males and 39 females, ranged the age from 19 to 57 years (averaged, 36.3 years), 50 cases in left, 45 cases in right. According to Schatzker classification, 51 cases were type V, 44 cases were VI. The data of operation time, intraoperative blood loss, complications (infectious of wound, necrosis, bad incision, collapse fracture, loosen of internal fixation, fracture failure)and recovery of function of lower limb joint were collected.
There were no significant difference among three groups in operation time (P > 0.05); blood loss in group A was obvious better than other groups (P < 0.05); collapse of joint surface and failure rate of internal fixation in group A was higher than other groups (P > 0.05); Merchant score after 1 year were higher in group B, C than group A. For lower limb function, 10 cases got excellent results, 5 good, 4 fair and 3 poor in group A; 21 cases got excellent results, 11 good, 3 fair and 1 poor in group B; 23 cases got excellent results, 11 good,2 fair and 1 poor in group C.
The blood loss in group A was least, but fracture exposure and joint surface was not satisfactory, and stable fixation could not be achieved, the long-term result was not good. For fractures with double condyles and dislocated involved, double plates through inside and outside incisions or double plates through antero-midline incisions was suggested,which benefit good reduction of joint surface, stable fixation, and erlier exercise.
探讨闭合性复杂胫骨平台骨折手术治疗的最佳选择、手术入路及其影响因素。
2003年1月至2011年1月，对95例闭合性复杂胫骨平台骨折患者进行Schatzker V型和Vl型评估，采用三种不同的手术方法进行治疗。方法包括经前外侧切口单钢板固定（A组，22例）、经内外侧切口双钢板固定（B组，36例）、经前正中切口双钢板固定（C组，37例）。其中男56例，女39例，年龄19～57岁，平均36.3岁，左侧50例，右侧45例。按Schatzker分型，V型51例，VI型44例。收集手术时间、术中出血量、并发症（伤口感染、坏死、切口不良、塌陷骨折、内固定松动、骨折不愈合）及下肢关节功能恢复情况等数据。
三组手术时间差异无统计学意义（P＞0.05）；A组术中出血量明显优于其他两组（P＜0.05）；A组关节面塌陷及内固定失败率高于其他两组（P＞0.05）；术后1年B组、C组Merchant评分高于A组。下肢功能方面，A组优10例，良5例，可4例，差3例；B组优21例，良11例，可3例，差1例；C组优2
