Yang E C, Weiner L, Strauss E, Sedlin E, Kelley M, Raphael J
Elmhurst Hospital, New York, New York, USA.
Am J Orthop (Belle Mead NJ). 1995 Sep;24(9):695-704.
A study was done of 44 metaphyseal dissociation fractures of the proximal tibia in 42 patients (27 men and 15 women, aged 22 to 77 years; mean, 42 years). Follow-up ranged from 6 months to 4 years. There were 2 study groups: a retrospective group (group 1, 22 fractures) given a variety of treatments ranging from casts to dual plates, and a prospective group (group 2, 22 fractures) treated by combining external fixation and optional minimal internal fixation. There were 12 comminuted fractures in group 1 and 20 in group 2 (P < 0.01). All fractures eventually healed, with an average healing time in group 1 of 3.8 months, and 5.3 months in group 2. There was one delayed union in group 2. Results were graded from poor to excellent, based on pain, range-of-motion, and malunion. There were 6 poor and 4 fair results in group 1, and no poor and 3 fair results in group 2. Complications included 6 deep infections, 5 in group 1 (1 requiring a free-flap procedure); and 1 pin-tract infection resulting in septic arthritis in group 2. There were 7 gastrocnemius flaps required in group 1, and 1 in group 2. The results of this study suggest that patients treated with external fixation had better results with less infection and soft-tissue complications than those treated with conventional internal fixation.
对42例患者（27例男性，15例女性，年龄22至77岁；平均42岁）的44例胫骨近端干骺端分离骨折进行了一项研究。随访时间为6个月至4年。有2个研究组：回顾性组（第1组，22例骨折）接受了从石膏固定到双钢板等多种治疗；前瞻性组（第2组，22例骨折）采用外固定结合选择性微创内固定治疗。第1组有12例粉碎性骨折，第2组有20例（P<0.01）。所有骨折最终均愈合，第1组平均愈合时间为3.8个月，第2组为5.3个月。第2组有1例延迟愈合。根据疼痛、活动范围和畸形愈合情况将结果分为差到优。第1组有6例结果差，4例结果一般；第2组无结果差的情况，3例结果一般。并发症包括6例深部感染，第1组5例（1例需要游离皮瓣手术）；第2组1例针道感染导致化脓性关节炎。第1组需要7例腓肠肌皮瓣，第2组需要1例。本研究结果表明，与传统内固定治疗的患者相比，外固定治疗的患者感染和软组织并发症较少，效果更好。
