CAJ | 학술논문

目的提出复杂胫骨平台骨折的改良Schatzker分型,探讨其临床应用价值. 方法根据胫骨平台骨折端有无垂直压缩,将2010年5月至2013年10月收治的205例SchatzkerⅤ、Ⅵ型胫骨平台骨折患者各自进一步分出2种亚型:垂直压缩型(Ⅴa型27例、Ⅵa型39例)66例和非垂直压缩型(Ⅴb型42例、Ⅵb型97例)139例.所有患者均行手术治疗,并比较垂直压缩和非垂直压缩型患者的各项主要临床指标:性别、年龄、损伤侧别、受伤机制、是否存在合并伤、肢体短缩长度、受伤至手术时间、手术时间、手术出血量、手术入路、手术复位情况、术后负重时间和美国特种外科医院(HSS)膝关节评分. 结果 205例患者术后获7 ～32个月(平均18.5个月)随访.Schatzker Ⅴa、Ⅵa型胫骨平台骨折患者的性别、损伤侧别、手术复位情况、术后HSS膝关节评分的优良率分别与Schatzker Ⅴb、Ⅵb型患者进行比较,差异均无统计学意义(P＞0.05),而在年龄、受伤机制、是否存在合并伤、肢体短缩长度、受伤至手术时间、手术时间、手术出血量、手术入路、术后负重时间等方面,差异均有统计学意义(P＜0.05).结论改良Schatzker分型能反映复杂垂直压缩型胫骨平台骨折的临床特点,可为其治疗提供个性化的治疗方案.
목적 제출복잡경골평태골절적개량Schatzker분형,탐토기림상응용개치. 방법 근거경골평태골절단유무수직압축,장2010년5월지2013년10월수치적205례SchatzkerⅤ、Ⅵ형경골평태골절환자각자진일보분출2충아형:수직압축형(Ⅴa형27례、Ⅵa형39례)66례화비수직압축형(Ⅴb형42례、Ⅵb형97례)139례.소유환자균행수술치료,병비교수직압축화비수직압축형환자적각항주요림상지표:성별、년령、손상측별、수상궤제、시부존재합병상、지체단축장도、수상지수술시간、수술시간、수술출혈량、수술입로、수술복위정황、술후부중시간화미국특충외과의원(HSS)슬관절평분. 결과 205례환자술후획7 ～32개월(평균18.5개월)수방.Schatzker Ⅴa、Ⅵa형경골평태골절환자적성별、손상측별、수술복위정황、술후HSS슬관절평분적우량솔분별여Schatzker Ⅴb、Ⅵb형환자진행비교,차이균무통계학의의(P＞0.05),이재년령、수상궤제、시부존재합병상、지체단축장도、수상지수술시간、수술시간、수술출혈량、수술입로、술후부중시간등방면,차이균유통계학의의(P＜0.05).결론 개량Schatzker분형능반영복잡수직압축형경골평태골절적림상특점,가위기치료제공개성화적치료방안.
Objective To analyze the clinical value of self-modified Schatzker classification of complex tibial plateau fractures.Methods From May 2010 to October 2013,205 patients with complex tibial plateau fracture of Schatzker type Ⅴ or Ⅵ were treated by surgery in our department.Their fracture types were further sub-classified into vertical compression subtype (subtype Ⅴ a in 27 cases and subtype Via in 39 cases) and no vertical compression subtype (subtype Ⅴb in 42 cases and subtype Ⅵb in 97 cases) according to the presence of vertical compression at the fracture ends.All patients were analyzed in terms of clinical variables,including gender,age,injury side,injury mechanism,associated injury,limb shortening length,time from injury to operation,operation time,blood loss,surgical approach,reduction,time for weight-bearing,and The Hospital for Special Surgery (HSS) score.Results 205 patients won follow-up from 7 to 32 months (average,18.5 months).There were no significant differences between subtypes a (Ⅴa and Ⅵa) and subtypes b (Ⅴb and Ⅵb) in gender,injury side,reduction,or HSS score (P ＞ 0.05),but there were significant differences in age,injury mechanism,associated injury,limb shortening length,time from injury to operation,operation time,blood loss,surgical approach and time for weight-bearing (P ＜0.05).Conclusion Our modified Schatzker classification of the complex tibial plateau fractures can reflect the major clinical characteristic of the complex tibial plateau fractures,vertical compression at the fracture ends,and therefore,it can help individualized treatment.