Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique
Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incision technique
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DOI：
10.1097/00005131-200411000-00001
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发表时间：
2004-11-01
影响因子：
2.3
通讯作者：
Benirschke, SK
中科院分区：
文献类型：
--
作者：
Barei, DP;Nork, SE;Benirschke, SK
目的：单切口切开复位双钢板固定治疗复杂胫骨平台骨折与伤口并发症发生率较高有关。与开放技术相比，微创方法被推荐来降低伤口并发症发生率。此外，横向应用的固定角度装置似乎可以最大限度地减少晚期内翻畸形，而不需要额外的内侧稳定。然而，粉碎的外侧和/或内侧关节面的精确复位通常需要通过切开复位来观察。本研究报告了与利用 2 个切口的双钢板复杂 AO/OTA 41-C3 胫骨平台骨折相关的并发症、感染率和放射学评估。设计：回顾性临床审查。地点：城市 1 级大学创伤中心。患者：在 77 个月的时间里，83 名患者在我们的机构接受了复杂双髁胫骨平台骨折的治疗。 2 切口技术。干预：使用前外侧和后内侧切口进行双钢板固定。主要结果测量：脓毒症和非脓毒症并发症的类型和发生率以及关节复位和轴向对齐的放射学评估。结果：11 例骨折为开放性骨折 (13.3%)，根据 Gustilo 分类为 II 型（1 例患者）、III-A 型（7 例患者）、III-B 型 （2 名患者）和 III-C 型（1 名患者）。 12 名患者 (14.5%) 被诊断为筋膜室综合征并接受筋膜切开术治疗。从受伤到最终手术治疗的平均时间间隔为 9 天。 7 名患者出现深部伤口感染（8.4%）。其中三人患有相关的化脓性关节炎（3.6%）。平均 3.3 次额外手术后感染临床消退。需要血管重建的血管障碍肢体的存在与深部伤口感染存在统计学相关性（P = 0.006）。并发症的二次手术包括 13 名因局部不适而需要移除植入物的患者、5 名需要膝关节操纵的患者、2 名需要切除异位骨化以改善膝关节活动的患者、1 名需要马蹄肌挛缩松解的患者以及 1 名因干骨干不愈合而接受治疗的患者。 16 名患者（19.3%）发生深静脉血栓。没有患者被诊断患有肺栓塞。 62% 的患者表现出满意的关节复位，91% 的患者表现出满意的冠状对位，72% 的患者表现出满意的矢状对位，98% 的患者表现出满意的髁宽度。结论：粉碎性双髁胫骨平台骨折可以通过切开复位和使用 2 个切口的内侧和外侧钢板固定来成功治疗。需要血管修复的血管障碍肢体发生深度脓毒症的风险增加。使用 2 个切口、临时跨越外固定以及适当的软组织处理可能有助于降低伤口并发症发生率。
Objectives: Single incision open reduction and double plate fixation of complex tibial plateau fractures has been associated with high wound complication rates. Minimally invasive methods have been recommended to decrease the Wound complication rates as compared with open techniques. Additionally, laterally applied fixed-angle devices appear to minimize late varus deformity without the need for additional medial stabilization. Accurate reduction of comminuted lateral and/or medial articular surfaces, however, often requires visualization through an open reduction. This Study reports the complications, infection rate, and radiographic assessment of reduction associated with double plating complex AO/OTA 41-C3 tibial plateau fractures utilizing 2 incisions.Design: Retrospective clinical review.Setting: Urban level 1 university trauma center.Patients: Over a 77-month period, 83 patients were treated for a complex bicondylar tibial plateau fracture at our institution utilizing a 2-incision technique.Intervention: Dual plating using anterolateral and posteromedial incisions.Main Outcome Measure: Type and incidence of septic and nonseptic complications and radiographic assessment of articular reduction and axial alignment.Results: Eleven fractures were open (13.3%) and classified according to Gustilo as type II (1 patient), type III-A (7 patients), type III-B (2 patients), and type III-C (1 patient). Compartment syndrome was diagnosed and treated with fasciotomies in 12 patients (14.5%). The average time interval from injury to definitive surgical treatment was 9 days. Seven patients developed deep wound infections (8.4%). Three of these had an associated septic arthritis (3.6%). Clinical resolution of infection Occurred after an average of 3.3 additional procedures. The presence of a dysvascular limb requiring vascular reconstruction was statistically associated with a deep wound infection (P = 0.006). Secondary procedures for complications included 13 patients who required removal of implants secondary to local discomfort, 5 patients who required a knee manipulation, 2 patients that were managed with excision of heterotopic ossification to improve knee motion, 1 patient that required an equinus contracture release, and 1 patient treated for a metadiaphyseal nonunion. Sixteen patients (19.3%) incurred deep venous thromboses. No patient was diagnosed with pulmonary embolism. Sixty-two percent of patients demonstrated satisfactory articular reductions, 91% demonstrated satisfactory coronal alignment, 72% demonstrated satisfactory sagittal alignment, and 98% demonstrated satisfactory condylar width.Conclusions: Comminuted bicondylar tibial plateau fractures can be successfully treated with open reduction and medial and lateral plate fixation using 2 incisions. Dysvascular limbs requiring vascular repair are at increased risk for deep sepsis. The use of 2 incisions, temporary spanning external fixation, and proper soft-tissue handling may contribute to a lower wound complication rate than previously reported.