林铭江苏省常州市中医医院骨伤科，江苏常州　213000

内外侧双钢板固定胫骨平台SchatzkerⅥ型骨折疗效分析

林铭
江苏省常州市中医医院骨伤科，江苏常州213000

目的探讨胫骨平台SchatzkerⅥ型骨折行内外侧双钢板固定术后的临床疗效，为胫骨平台SchatzkerⅥ型骨折手术治疗提供指导和参考。方法分析2012年1月～2014年12月间本院收治的SchatzkerⅥ型胫骨平台骨折患者39例，术前行DR及CT平扫加三维重建明确骨折具体部位、关节塌陷移位程度；术中采用胫骨近端内外侧双钢板螺钉固定；术后予以抗感染抗血栓治疗，辅以关节屈伸功能锻炼和器械辅助训练。观察患者术后骨折愈合及膝关节功能恢复情况。 结果术后随访12个月，39例患者全部获得骨性愈合。参照HSS膝关节功能评分：优23例，良14例，中2例，总优良率为94.9%。术后患者在疼痛、关节功能、活动度、屈曲畸形、关节稳定性等方面均有显著改善，与术前比较，差异有统计学意义（P＜0.05）。结论内外侧双钢板固定治疗胫骨平台SchatzkerⅥ型骨折固定可靠，术后配合关节功能锻炼和器械训练，关节功能恢复效果良好。

胫骨平台；SchatzkerⅥ型；骨折；内外侧固定；双钢板

［Abstract］Objective To discuss the c1inica1 effect of media1 and 1atera1 dua1 p1ates fixation in tibia1 p1ateau fracture of SchatzkerⅥ type，and to provide guidance and reference for operation on tibia1 p1ateau fracture of SchatzkerⅥ. Methods 39 patients with tibia1 p1ateau fracture of SchatzkerⅥtreated in our hospita1 from January 2012 to December 2014 were se1ected.The patients were examined by DR and CT scan p1us three-dimensiona1 reconstruction before operation to define the exact 1ocation of fracture and co11apse and disp1acement of joint.Media1 and 1atera1 dua1 p1ates fixation at proxima1 tibia was conducted in the operation.Anti-infection and antithrombotic therapy was given after operation combined with functiona1 exercise of joint f1exion and extension and auxi1iary equipment training.The hea1ing status of fracture and reconstruction of knee joint function of patients were observed.Results The patients were fo1-1owed up for 12 months.Bone hea1ing was observed in a11 of the 39 patients.According to the HSS knee joint function sca1e，23 cases were exce11ent，14 cases were good，and 2 patients were moderate，with an exce11ent and good rate of 94.9%.After operation，the patients a11 reported significant improvement in pain remission，joint function，range of motion，remission of f1exion deformity and stabi1ity of knee joint，which was significant1y different when compared with those before operation（P＜0.05）.Conclusion Media1 and 1atera1 dua1 p1ates fixation is a re1iab1e therapy in treatment of tibia1 p1ateau fracture of SchatzkerⅥtype.Combined with functiona1 exercise and equipment training，the reconstruction of joint function is favorab1e.

［Key words］Tibia1 p1ateau；SchatzkerⅥ；Fracture；Media1 and 1atera1 fixation；Dua1 p1ates

胫骨平台骨折是临床较为常见的关节内骨折，系高能量损伤所致［1］。常表现为关节面的压缩、塌陷或胫骨平台劈裂，多合并关节软组织损伤，属于临床手术较为困难的骨折类型［2，3］。如果治疗方法选择不当，将严重影响愈合效果甚至患者预后，严重者病变部位可发生畸形或功能残疾［4］。本文以2012年1月～2014年12月期间入院治疗的39例SchatzkerⅥ型骨折患者为研究对象，经笔者采用膝前外侧联合内侧直行或倒L型切口，双钢板固定治疗，术后临床效果较好，现报道如下。……