Surgical Strategy and Efficacy Analysis of Complex Tibial Plateau Fractures_West China Medical Journal

Authors：

LI Jun , ZHANG Xingrui , HU Wenyong

Department of Orthopedics, the First People’s Hospital of Liangshan, Liangshan, Sichuan 615000, P.R.China;

Corresponding?author：

Keywords：

脛骨平臺骨折; 雙鋼板; 內固定術

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【摘要】　目的　探討復雜型脛骨平臺骨折改良手術入路及雙側雙鋼板固定臨床療效。　方法　 2006年3月—2008年12月，收治復雜型脛骨平臺骨折21例，其中男14例，女7例；平均年齡37歲。按Schatzker骨折分類：Ⅴ型10例，Ⅵ型11例。均選擇前外側聯合后內側或后側入路，雙側雙鋼板固定，術中探查半月板及交叉韌帶損傷，一期修復處理及行交叉韌帶重建。　結果　術后傷口Ⅰ期愈合19例，Ⅱ期愈合1例，1例術后10 d發生切口皮緣壞死，經換藥后愈合。所有患者均獲1~3年隨訪，平均19.5個月。骨性愈合時間5~10個月，平均7.4個月。出現創傷性關節炎2例，關節面塌陷2例，其中1例有輕度膝關節內翻。按美國特種外科醫院評分標準：優18例，良2例，可1例，優良率95.2%。　結論　復雜型脛骨平臺骨折運用前外側聯合后內或后側切口入路，雙側雙鋼板固定，利于保護軟組織血供、固定可靠穩定性好，是切實可行的有效方法。
【Abstract】　Objective　 To study the clinical efficacy of modified surgical approach and bilateral double-plate fixation in the cases of complex tibial plateau fracture.　Methods　 From March 2006 to December 2008, 21 patients with complex tibial plateau fracture, including 14 males and seven females, were treated in our hospital. The average age of them was 37 years old. Based on Schatzker fracture classification, there were 10 cases of type Ⅴ and 11 cases of type Ⅵ fracture. All the cases were treated by the combined anterolateral and posteromedial or posterior approaches and bilateral double-plate fixation. In the operation, we explored injuries on the meniscus and cruciate ligament, and carried out the one-stage rehabilitation and cruciate ligament reconstruction.　Results　 There were 19 cases of one-stage healing, and one case of secondary healing. One patient suffered skin flap necrosis 10 days after the operation, and was cured after changing the medicine. All the patients were followed up for one to three years, averaging at 19.5 months. Bone healing occurred within 5 to 10 months averaging at 7.4 months. Two patients suffered traumatic arthritis; articular surface collapse was found in two patients; and one patient had mild varus knee. According to the scoring system from Hospital for Special Surgery, there were 18 cases of excellent efficacy, two of good efficacy, one of fair efficacy, with an excellence rate of 85.2%.　Conclusion　 Combined anterolateral and posteromedial or posterior approaches and bilateral double-plate fixation for complex tibial plateau fractures is beneficial to protect the soft tissue blood supply and give reliable fixation stability. Thus, it is a feasible and effective method and is worth further research and popularizing in clinical practices.

Citation： LI Jun,ZHANG Xingrui,HU Wenyong. Surgical Strategy and Efficacy Analysis of Complex Tibial Plateau Fractures. West China Medical Journal, 2011, 26(6): 890-892. doi: Copy

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10.	Westmoreland GL, McLaurin TM, Hutton WC. Screw pullout strength: a biomechanical comparison of large-fragment and small fragment fixation in the tibial plateau[J]. J Orthop Trauma, 2002, 16(3): 178-181.
11.	Gosling T, Schandelmaier P, Muller M, et al. Single lateral locked screw plating of bicondylar tibial plateau fractures[J]. Clin Orthop Relat Res, 2005, 439: 207-214.
12.	Stannard JP, Wilson TC, Volgas DA, et al. The less invasive stabilization system in the treatment of complex fracturse of the tibial plateau: short-term results[J]. J Orthop Trauma, 2004, 18(8): 552-558.
13.	Gösling T, Schandelmaier P, Marti A, et al. Less invasive stabilization of complex tibial plateau fractures: a biomechanical evaleation of a unilateral locked screw plate and double plating[J]. J Orthop Trauma, 2004, 18(8): 546-551.
14.	葛志斌, 張前法, 龐清江. 重組合異種骨加鋼板內固定治療脛骨平臺骨折[J]. 中國修復重建外科雜志, 2004, 18(4): 272-274.

1. 　Gardner MJ, Yacoubian S, Geller D, et al. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients[J]. J Orthop Trauma, 2005, 19(2): 79-84.
2. 　Canale ST. 坎貝爾骨科手術學[M]. 9版. 盧世壁, 譯. 濟南: 山東科技出版社, 2001: 2048-2049.
3. 　李新忠, 陳道運, 胡珍珠, 等. 復雜性脛骨平臺骨折的治療(120例隨訪分析)[J]. 中國矯形外科雜志, 2008, 16(22): 1739-1740.
4. 　劉志雄. 骨科常用診斷分類方法和功能結果評定標準[M]. 北京: 北京科學技術出版社, 2005: 125-275.
5. 　曾炳芳, 羅從鳳. 重視脛骨近端骨折的治療[J]. 中華創傷骨科雜志, 2004, 6(3): 241-243.
6. 　Sommer C, Gautier E, Müller M, et al. First clinical results of the loching compression plate (LCP)[J]. Injury, 2003, 34 (Suppl 2): 43-54.
7. 　Egol KA, Su E, Tejwani NC, et al. Treatment of complex tibial plateau fractures using the less invasive stabilization system plate: clinical experience and a laboratory comparison with double plating[J]. J Trauma, 2004, 57(2): 340-346.
8. 　Mills WJ, Nork SE. Open reduction and internal fixation of high-energy tibial plateau fractures[J]. Orthop Clin North Am, 2002, 33(1): 177-198.
9. 　Wu CC, Tai CL. Plating treatmena for tibial plateau fractures: a biomechanical comparison of buttress and tension band positions[J]. Arch Orthop Trauma Surg, 2007, 127(1): 19-24.
10. 　Westmoreland GL, McLaurin TM, Hutton WC. Screw pullout strength: a biomechanical comparison of large-fragment and small fragment fixation in the tibial plateau[J]. J Orthop Trauma, 2002, 16(3): 178-181.
11. 　Gosling T, Schandelmaier P, Muller M, et al. Single lateral locked screw plating of bicondylar tibial plateau fractures[J]. Clin Orthop Relat Res, 2005, 439: 207-214.
12. 　Stannard JP, Wilson TC, Volgas DA, et al. The less invasive stabilization system in the treatment of complex fracturse of the tibial plateau: short-term results[J]. J Orthop Trauma, 2004, 18(8): 552-558.
13. 　Gösling T, Schandelmaier P, Marti A, et al. Less invasive stabilization of complex tibial plateau fractures: a biomechanical evaleation of a unilateral locked screw plate and double plating[J]. J Orthop Trauma, 2004, 18(8): 546-551.
14. 　葛志斌, 張前法, 龐清江. 重組合異種骨加鋼板內固定治療脛骨平臺骨折[J]. 中國修復重建外科雜志, 2004, 18(4): 272-274.

West China Medical Journal

Surgical Strategy and Efficacy Analysis of Complex Tibial Plateau Fractures

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