三柱理论指导下治疗胫骨平台粉碎性骨折的临床疗效观察  

The clinical curative effect of the internal fixation under the guidance of three-column theory in treating tibial plateau fracture

作　　者：张志文[1] 黄玉良[1] 巫洪波[1] 王晓锋[1] 

机构地区：[1]惠州市中心人民医院创伤骨科,广东516001

出　　处：《创伤外科杂志》2016年第11期663-665,677,共4页Journal of Traumatic Surgery

摘　　要：目的探讨三柱理论指导下锁定钢板三柱固定治疗胫骨平台粉碎性骨折的临床疗效。方法回顾性分析2009年1月-2012年12月收治的胫骨平台粉碎性骨折患者40例,均为三柱骨折,其中男性25例,女性15例;年龄29-64岁,平均（36.6±3.1）岁。均采用漂浮体位下三柱侧柱锁定钢板固定,平台塌陷处以同种异体骨植入,术后随访2年,X线片观察骨折复位及愈合程度,比较美国特种外科医院（HSS）膝关节功能评分、Rasmussen评分,并观察并发症的发生情况。结果所有患者术后均得到良好固定,膝关节内翻角和后倾角均得到很好纠正,Rasmussen放射学评分满意,术后与术前比较差异有统计学意义（P〈0.05）。膝关节功能恢复满意,术后2年HSS评分优良率达到90%。除2例出现轻度创伤性关节炎外,其他患者无明显并发症。结论三柱固定理论有利于更好地指导胫骨平台粉碎性骨折的临床治疗,主要体现在中期随访中,锁定钢板三柱固定可使骨折获得更好的复位和牢固的固定,安全性较高,值得临床推广。Objective To investigate the clinical effect of comminuted tibial three-column locking plate fixation under the guidance of three column theory in the treatment of plateau fracture. Methods Forty cases in our hospital from Jan. 2009 to Dec. 2012 with comminuted fracture of tibial plateau were collected,including 25 male cases and 15 female cases aging 29-64（ 36. 6 ± 3. 1） years. All patients adopted locking plate with allogenous bone grafting in floating position. After postoperative follow-up of 2 years,fracture reduction and healing were observed by X-ray,and the hospital for special surgery（ HSS） score and Rasmussen score were compared. At the same time the complications were also observed. Results The fixation was good in all patients,with postoperative knee varus angle and dip angle well corrected. The postoperative Rasmussen score was satisfied,with significant difference compared with that before operation（ P〈0. 05）. Knee joint function was restored. According to HSS score,the excellent and good rate of knee joint function was 90% in postoperative 2 years. There were no obvious complications except2 patients with traumatic arthritis. Conclusion Three-column fixation theory is conducively benificial in clinical treatment of comminuted tibial plateau fracture,mainly in the medium-term follow-up. Three-column fixation can lead to better fracture reduction and stable fixation with high security,and is worth clinical promotion.

关 键 词：胫骨平台骨折 锁定钢板 三柱固定 植骨 

分 类 号：R683.42[医药卫生—骨科学]