Stamer D T, Schenk R, Staggers B, Aurori K, Aurori B, Behrens F F
Department of Orthopaedics, New Jersey Medical School University of Medicine and Dentistry of New Jersey, Newark.
J Orthop Trauma. 1994 Dec;8(6):455-61.
Twenty-three knees in 22 patients with Schatzker type VI tibial plateau fractures were treated with a hybrid ring external fixator using tensioned wires proximally and half-pins distally. All but two injuries were secondary to high-energy trauma. Six were open injuries, and eight patients had other major musculoskeletal trauma. Eight patients were treated with limited open reduction and internal fixation before application of the frame. The remainder received percutaneous cannulated screw fixation to stabilize the articular surface without opening the fracture site. Twenty-three fractures were followed to complete healing. Average time to healing was 4.4 months. Arc of motion averaged 107 degrees, and there were four flexion contractures of 5-15 degrees. Complications consisted of three deep wound infections, one deep venous thrombosis (DVT), one malunion, and one pin tract infection. The average knee score and patient function score were 84.7 and 80.5, respectively (Knee Society Clinical Rating System). There were 13 excellent, three good, one fair, and six poor results. The poor results were in patients who either developed deep wound infections or in those who sustained multiple musculoskeletal trauma compromising the patients' function score and ultimately the average score. This method provides good stabilization and allows early range of motion for complex tibial plateau fractures where extensive dissection and internal fixation are contraindicated due to traumatized soft tissue, osteopenia, and fracture comminution.
22例Schatzker VI型胫骨平台骨折患者的23个膝关节采用混合环形外固定器治疗，近端使用张力钢丝，远端使用半针。除2例损伤外，其余均为高能创伤所致。6例为开放性损伤，8例患者合并其他严重的肌肉骨骼创伤。8例患者在应用外固定架前接受了有限切开复位内固定治疗。其余患者接受经皮空心螺钉固定以稳定关节面，未打开骨折部位。23处骨折均随访至完全愈合。平均愈合时间为4.4个月。平均活动弧度为107度，有4例膝关节屈曲挛缩5 - 15度。并发症包括3例深部伤口感染、1例深静脉血栓形成（DVT）、1例骨不连和1例针道感染。膝关节平均评分和患者功能评分分别为84.7和80.5（膝关节协会临床评分系统）。结果为优13例、良3例、可1例、差6例。差的结果出现在发生深部伤口感染的患者或遭受多处肌肉骨骼创伤从而影响患者功能评分并最终影响平均分的患者中。对于复杂的胫骨平台骨折，由于软组织损伤、骨质减少和骨折粉碎，广泛的切开和内固定是禁忌的，这种方法提供了良好的稳定性，并允许早期进行活动。
