Yao Yunfeng, Lv Hao, Zan Junfeng, Li Jun, Zhu Nan, Jing Juehua
Injury. 2014 Dec;45(12):1980-4. doi: 10.1016/j.injury.2014.10.004.
Although there are different ways to treat bicondylar tibial plateau fractures, treatment remains as a challenge to most orthopaedic surgeons. The purpose of this study was to assess the outcomes of dual buttress plates fixation in treatment of bicondylar tibial plateau fractures and to determine risk factors for outcome.
Clinical data for 74 patients with bicondylar tibial plateau fracture were retrospectively reviewed. Dual buttress plates were placed through two incisions. All patients were evaluated both radiographically and clinically according to Rasmussen scores and Hospital for Special Surgery (HSS) scores during the follow-up period. The data were analyzed using univariate analysis and multivariate logistic regression analysis to identify independent risk factors for functional outcome (Rasmussen functional score).
Rasmussen anatomic score was excellent in 34, good in 23, and fair in 17 patients. Sixty-nine patients were followed for a mean of 27 months. Functional results of excellent and good were obtained in 56(81.2%) patients by Rasmussen functional score and in 57 (82.6%) patients by HSS score. Univariate analysis showed Arbeitsgemeinschaft für Osteosynthesefragen (AO) fracture type and reduction quality were significantly related to functional results. Multivariate analysis showed that AO fracture type and reduction quality were independent risk factors for outcome.
Dual buttress plates technique provided a favourable quality of fracture reduction and satisfactory clinical function. Appropriate selection for operation chance, limited soft tissue stripping and filling of osseous defects may lessen or prevent serious complications. Fracture reduction quality and AO fracture type were independent risk factors for clinical function.
虽然治疗双髁胫骨平台骨折有不同方法，但对大多数骨科医生而言，治疗仍是一项挑战。本研究的目的是评估双支撑钢板固定治疗双髁胫骨平台骨折的疗效，并确定影响疗效的危险因素。
回顾性分析74例双髁胫骨平台骨折患者的临床资料。通过两个切口置入双支撑钢板。在随访期间，根据Rasmussen评分和特殊外科医院（HSS）评分对所有患者进行影像学和临床评估。采用单因素分析和多因素logistic回归分析数据，以确定功能结局（Rasmussen功能评分）的独立危险因素。
Rasmussen解剖评分优34例，良23例，可17例。69例患者平均随访27个月。根据Rasmussen功能评分，56例（81.2%）患者功能结果为优或良；根据HSS评分，57例（82.6%）患者功能结果为优或良。单因素分析显示，AO骨折类型和复位质量与功能结果显著相关。多因素分析显示，AO骨折类型和复位质量是影响结局的独立危险因素。
双支撑钢板技术能提供良好的骨折复位质量和满意的临床功能。合理选择手术时机、有限的软组织剥离和骨缺损填充可减少或预防严重并发症。骨折复位质量和AO骨折类型是临床功能的独立危险因素。
