学术动态

关键词：胫骨平台骨折：内/外固定

    胫骨平台骨折常见的并发症是内侧塌陷，本研究的目的在于通过观察累及双髁的胫骨平台骨折术后膝内翻的程度来比较不同的内固定方式的疗效。依内固定器材和固定方式不同，本研究共使用了四种内固定方法。

    对自2005年1月至2007年11月间接受切开复位内固定术治疗的62例累及双髁的胫骨平台骨折患者的临床资料进行回顾性分析。

内固定方法为一下4种方法中的1种：

（1）胫骨平台外侧单向锁定钢板固定；（2）胫骨平台外侧单向锁定钢板结合内侧支撑钢板；（3）胫骨平台外侧多向锁定钢板；（4）胫骨平台外侧多向锁定钢板结合内侧支撑钢板，膝内翻情况由手术后即到X光片测量值和其后随访时的测量值进行比较。

单轴向与多轴向锁定钢板都能有效避免术后出现严重的膝内翻畸形，比较两种不同钢板治疗后复位丢失率之间的差别仅为0.0085˚，另外，外侧平台单钢板固定与内外侧平台双钢板方法相比，在避免术后出现严重膝内翻畸形及复位丢失率上无区别。

    在治疗累及内外侧髁胫骨平台骨折上，单就防止术后内翻畸形这点上分析，多轴向锁定钢板与单轴向锁定钢板疗效相近，另外，外侧单钢板固定与内外侧平台双钢板固定疗效相近。

 

Varus collapse is a complication associated with tibial plateau fractures. This study was designed to assess progressive genu varus formation following open reduction and internal fixation (ORIF) of bicondylar tibial plateau fractures as well as determining which, if any, construct was superior in the prevention of genu varus formation. Four constructs were evaluated.

METHODS

Areview of 62 consecutive patients that underwent ORIF for bicondylar tibial plateau fractures from 01/2005 to 11/2007. The bicondylar tibial plateau fractures were treated with one of four constructs. They were (1) a single vector locking plate applied to the lateral border, (2) a single vector locking plate applied to the lateral border with an additional medial buttress plate, (3) a variable angled locking plate applied to the lateral border, and (4) a variable angled locking plate applied to the lateral border with an additional medial buttress plate. Possible progressive genus varus was determined by measuring knee alignment on immediate postop x-rays and all available follow up x-rays

RESULTS

Neither the variable angle locked screw plating system nor the single vector locked screw plating system was associated with significant varus collapse, and the difference in collapse rates over the time intervals between the two groups was just 0.0085 degrees. Additionally, neither the lateral plating systems nor the dual plating systems showed significant differences in collapse, and the difference in collapse rates over the time intervals between the two groups was just 0.0688 degrees.

DISCUSSION AND CONCLUSION

The variable angle locked screw plating system tested was noted to be a viable alternative to a single vector locked screw plating system with regard to any propensity for varus collapse at the knee, after treatment of bicondylar tibia plateau fractures. Additionally, lateral plating was equivalent to dual plating in the assessment of progressive genu varus.