University Hospitals Bristol NHS Foundation Trust, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK.
Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3052, Australia.
Bone Joint J. 2014 Jul;96-B(7):956-62. doi: 10.1302/0301-620X.96B7.32837.
Unstable bicondylar tibial plateau fractures are rare and there is little guidance in the literature as to the best form of treatment. We examined the short- to medium-term outcome of this injury in a consecutive series of patients presenting to two trauma centres. Between December 2005 and May 2010, a total of 55 fractures in 54 patients were treated by fixation, 34 with peri-articular locking plates and 21 with limited access direct internal fixation in combination with circular external fixation using a Taylor Spatial Frame (TSF). At a minimum of one year post-operatively, patient-reported outcome measures including the WOMAC index and SF-36 scores showed functional deficits, although there was no significant difference between the two forms of treatment. Despite low outcome scores, patients were generally satisfied with the outcome. We achieved good clinical and radiological outcomes, with low rates of complication. In total, only three patients (5%) had collapse of the joint of > 4 mm, and metaphysis to diaphysis angulation of 75º, and five patients (9%) with displacement of > 4 mm. All patients in our study went on to achieve full union. This study highlights the serious nature of this injury and generally poor patient-reported outcome measures following surgery, despite treatment by experienced surgeons using modern surgical techniques. Our findings suggest that treatment of complex bicondylar tibial plateau fractures with either a locking plate or a TSF gives similar clinical and radiological outcomes.
不稳定性双髁胫骨平台骨折较为罕见，文献中关于最佳治疗方法的指导也很少。我们对两个创伤中心连续收治的一系列此类损伤患者的短期至中期结果进行了研究。2005 年 12 月至 2010 年 5 月，共有 54 例患者的 55 处骨折接受了固定治疗，其中 34 例采用关节周围锁定钢板固定，21 例采用有限接触直接内固定联合 Taylor 空间框架（TSF）环形外固定。至少在术后 1 年时，采用 WOMAC 指数和 SF-36 评分等患者报告的结果测量指标显示存在功能缺陷，尽管两种治疗方法之间无显著差异。尽管结果评分较低，但患者总体对结果感到满意。我们获得了良好的临床和影像学结果，并发症发生率低。总共只有 3 名患者（5%）出现关节塌陷>4mm，骨干到干骺端成角 75°，5 名患者（9%）出现>4mm 的移位。我们研究中的所有患者均实现了完全愈合。这项研究强调了这种损伤的严重性质，以及尽管由经验丰富的外科医生采用现代手术技术进行了治疗，但术后患者报告的结果测量指标通常较差。我们的研究结果表明，对于复杂的双髁胫骨平台骨折，使用锁定钢板或 TSF 治疗可获得相似的临床和影像学结果。
