双切口双侧钢板内固定治疗Schatzker VI型胫骨平台骨折

Double-incision double-plate fixation of Schatzker type VI tibial plateau fractures

摘要:

[目的] 探讨双切口双侧钢板内固定 （double incision double plate internal fixation, DIDPIF） 治疗 Schatzker VI 型胫骨平台骨折（tibial plateau fracture, TPF）的疗效。[方法]回顾性分析本院 2021 年 6 月—2023 年 6 月收治的 54 例接受 DIDPIF 治疗的 Schatzker VI 型 TPF 患者临床资料，评价临床及影像结果。[结果]54 例 TPF 患者均成功完成手术，手术时间平均（100.0± 11.6） min，术中失血量平均 （270.5±40.3） mL，下地行走时间平均 （9.4±2.5） d，住院时间平均 （10.2±2.0） d。随访时间平均 （15.0±2.0）个月，与术后 3 个月相比，末次随访 VAS [(2.3±0.6), (1.0±0.3), P＜0.001]、HSS 评分 [(63.2±7.4), (90.0±8.5), P＜0.001] 及膝伸-屈 ROM [(90.3±3.7), (119.4±4.6), P＜0.001] 均显著改善。影像方面，与术后即刻相比，末次随访时，胫骨近端内侧角（medial proximal tibail angle, MPTA）、胫骨后倾角（proximal tibail slope, PTS）均无差异（P＞0.05），与术后 3 个月相比，末次随访 K-L 评级无显著变化（P＞0.05）。[结论]DIDPIF 治疗 Schatzker VI 型 TPF 具有解剖复位质量良好、稳定性强的特点，有利于膝关节功能及活动度改善。

Abstract:

[Objective] To investigate the clinical efficacy of double-incision double-plate internal fixation (DIDPIF) in the treatment of Schatzker type VI tibial plateau fracture (TPF). [Methods] A retrospective study was conducted on 54 patients who received DIDPIF for Schatzker type VI TPF in our hospital from June 2021 to June 2023. The clinical and imaging data were evaluated. [Results] All the 54 patients were successfully operated on, with an average operation time of (100.0±11.6) min, an average intraoperative blood loss of (270.5± 40.3) mL, an average walking time of (9.4±2.5) days, and an average hospital stay of (10.2±2.0) days. No complications, such as neurovascular injury and incision infection occurred in anyone during perioperative period. They were followed up for a mean of (15.0±2.0) months. The VAS score significantly decreased at the last follow-up compared with that 3 months after surgery [(1.0±0.3) vs (2.3±0.6), P＜0.001], whereas the HSS score [(90.0±8.5) vs (63.2±7.4), P＜0.001] and knee extension-flexion ROM [(119.4±4.6)° vs (90.3±3.7)°, P＜0.001] significantly increased. Compared with those immediately after surgery, the MPTA and PTS remained unchanged remarkably at the latest follow-up (P＞ 0.05), and there was no a significant variation in K-L scale between the time points 3 months after surgery and latest follow-up (P＞0.05). [Conclusion] DIDPIF for Schatzker type VI TPF has advantages of good anatomic reduction quality and strong stability, which is conducive to the improvement of knee function and motion.