临时跨关节外固定支架固定联合延期内固定治疗复杂胫骨平台骨折  

Staged treatment of complex tibial plateau fractures with temporary transarticular external fixation and delayed plate fixation

作　　者：陈农[1] 马易群[1] 周凯华[1] 周海林[1] 陶星光[1] 潘福根[1] 

机构地区：[1]复旦大学附属中山医院青浦分院骨科,上海201700

出　　处：《中华创伤骨科杂志》2016年第4期312-317,共6页Chinese Journal of Orthopaedic Trauma

基　　金：上海市卫生局资助项目（20124304）;上海市医学重点专科建设资助项目（ZK2012A36）;上海市青浦区卫生计生系统学科带头人（WD2015-08）

摘　　要：目的比较临时跨关节外固定支架固定联合延期钢板内固定与跟骨牵引联合钢板内固定治疗复杂胫骨平台骨折的疗效。方法回顾性分析2011年1月至2014年1月治疗的44例复杂胫骨平台骨折患者资料。按治疗方式不同分为2组：观察组22例（采用临时跨关节外固定支架固定结合钢板内固定），男14例，女8例；平均年龄（45．5±11．4）岁；左侧10例，右侧12例；骨折按Schatzker分型：V型13例，Ⅵ型9例。对照组22例（采用跟骨牵引联合钢板内固定），男13例，女9例；平均年龄（43．84-10．4）岁；左侧8例，右侧14例；骨折按Schatzker分型：V型12例，Ⅵ型10例。比较两组患者入院至内固定时间、手术时间等及末次随访时美国特种外科医院（HSS）膝关节功能评分。两组患者术前一般资料比较差异均无统计学意义（P〉0．05），有可比性。结果44例患者术后获12～30个月（平均18．6个月）随访。两组患者在人院至内固定时间、手术时间、术中出血量和住院时间方面差异均有统计学意义（P〈0．05）；观察组与对照组患者并发症发生率分别为4．5％（1／22）、27．3％（6／22），差异有统计学意义（P〈0．05）；末次随访时HSS膝关节功能评分优良率分别为86．3％（19／22）、81．8％（18／22），差异无统计学意义（P〉0．05）。结论两种方法均可治疗复杂胫骨平台骨折，但与跟骨牵引联合钢板内固定相比，临时跨关节外固定支架固定联合延期钢板内固定能缩短住院时间、减少术中出血量，且术后并发症明显减少，膝关节功能恢复满意。Objective To evaluate the clinical efficacy of staged treatment of complex tibial plateau fractures with temporary transarticular external fixation and delayed plate fixation. Methods Enrolled in this study were 44 cases of complex tibial plateau fracture who had been treated from January 2011 to January 2014. Temporary transarticular external fixation and delayed plate fixation was adopted in 22 patients （observation group）, involving 14 men and 8 women with an average age of 45.5 ＋ ll. 4 years, and 10 left sides and 12 right sides. By the Schatzker classification, 13 cases were type V and 9 type VI. Calcaneal traction and plate fixation was adopted in the other 22 patients （control group）, involving 13 men and 9 women with an average age of 43.8 -＋ 10. 4 years, and 8 left sides and 14 right sides. By the Schatzker classification, 12 cases were type V and 10 type VI. The 2 groups were evaluated by the time from hospitalization to plate fixation, operation time, intra-operative bleeding volume, hospitalization time, healing time, complications and Hospital for Special Surgery （HSS） scoring at the final follow-ups. The 2 groups were compatible with no significant differences regarding the preoperative general data （ P 〉 0.05 ） . Results The 44 patients were followed up for 12 to 30 months （mean, 18.6 months）. There were significant differences between the 2 groups in the time from hospitalization to plate fixation, operation time, intra-operative bleeding volume and hospitalization time （P 〈 0.05）. There was also a significant difference in the complications rate （4. 5% （1/22） for the observation group versus 27.3% （6/22） for the control group） （P 〈 0. 05）, but there was no significant difference in the good to excellent rate by HSS scoring [86.3% （19/22） versus 8l. 8% （ 18 / 22 ） ] （ P 〉 0. 05 ）. Conclusions Although both methods can treat complex tibial plateau fractures, temporary transarticular external fixation and delayed plate fixation may be

关 键 词：外固定器 胫骨骨折 骨折固定术 内 膝关节 

分 类 号：R687.3[医药卫生—骨科学]