【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.
High performance liquid chromatography (HPLC) is currently the mainstream technology for detecting hemoglobin. Glycated hemoglobin (HbA1c) is a gold indicator for diagnosing diabetes, however, the accuracy of HbA1c test is affected by thalassemia factor hemoglobin F (HbF)/hemoglobin A2 (HbA2) and variant hemoglobin during HPLC analysis. In this study, a new anti-interference hemoglobin analysis system of HPLC is proposed. In this system, the high-pressure three-gradient elution method was improved, and the particle size and sieve plate aperture in the high-pressure chromatography column and the structure of the double-plunger reciprocating series high-pressure pump were optimized. The system could diagnose both HbA1c and thalassemia factor HbF/HbA2 and variant hemoglobin, and the performance of the system was anti-interference and stable. It is expected to achieve industrialization. In this study, the HbA1c and thalassemia factor HbF/HbA2 detection performance was compared between this system and the world’s first-line brand products such as Tosoh G8, Bio-Rad Ⅶ and D10 glycosylated hemoglobin analysis system. The results showed that the linear correlation between this system and the world-class system was good. The system is the first domestic hemoglobin analysis system by HPLC for screening of HbA1c and thalassemia factor HbF/HbA2 rapidly and accurately.