Objective: To investigate the short-term effectiveness of proximal tibial lateral raft plate combined combined with or without Jail screw fixation in the treatment of tibial plateau collapse fractures involved posterior-lateral column.
Methods: A retrospective analysis was performed on 106 patients (106 knees) with tibial plateau collapse fracture involved posterior-lateral column admitted between January 2016 and January 2021. According to the combination with Jail screw fixation or not, patients were divided into control group (treated by lateral raft plate without Jail screw fixation, 52 cases) and study group (treated by lateral raft plate with Jail screw fixation, 54 cases). There was no significant difference between the two groups in terms of gender, age, affected knee side, cause of injury, Schatzker classification, Tscherne-Gotzen classification, time from injury to operation, and preoperative lateral tibial plateau posterior slope angle (PSA), tibial plateau varus angle (TPVA), Rasmussen anatomical score (P>0.05). The operation time, cumulative fluoroscopy time, intraoperative blood loss, hospitalization stay, fracture healing time, complications, and lateral tibial plateau PSA, TPVA, Rasmussen anatomical score detected by X-ray films and CT before operation and at 1 year after operation of the two groups were recorded and compared. The number of cases of articular surface collapse in the two groups was recorded at 1 year after operation, and the effectiveness was evaluated by American Special Surgery Hospital (HSS) score.
Results: All patients were followed up 12-32 months (mean, 19.5 months). There was no significant difference between the two groups in operation time, cumulative fluoroscopy time, intraoperative blood loss, hospitalization stay, and fracture healing time (P>0.05). There were 2 patients (3.7%) in the study group and 3 patients (5.8%) in the control group with superficial wound infection, which were cured after debridement and dressing change. There was no significant difference in the incidence between the two groups (χ2=0.252, P=0.616). There was no complication such as vascular and nerve injury, internal fixation failure, nonunion or malunion of fracture, and deep vein thrombosis of lower limbs in both groups. At 1 year after operation, 9 cases (17.3%) in the control group had joint collapse of 2-3 mm, while only 2 cases (3.7%) in the study group had joint collapse, showing significant difference (χ2=5.271, P=0.022). At 1 year after operation, the PSA, TPVA, and Rasmussen anatomical scores of the two groups were significantly improved when compared with preoperative ones (P<0.05); the differences of pre- and post-operative PSA, TPVA, Rasmussen anatomical score, and postoperative HSS score in the study group were significantly better than those in the control group (P<0.05).
Conclusion: The lateral raft plate combined with or without Jail screw fixation can achieve satisfactory short-term effectiveness in the treatment of tibial plateau collapse fractures involved posterior-lateral column. Combined with Jail screw, it can enhance the fixation and avoid the occurrence of secondary articular surface collapse, which can be used as a better choice.
目的: 比较外侧排筏钢板结合Jail螺钉固定与单独外侧排筏钢板固定治疗累及后外侧柱的胫骨外侧平台塌陷骨折的近期临床疗效。.
方法: 回顾分析2016年1月—2021年1月收治的106例（106膝）累及后外侧柱的胫骨外侧平台塌陷骨折患者。根据是否联合Jail螺钉固定，分为对照组（单纯采用外侧排筏钢板固定，52例）和研究组（外侧排筏钢板联合Jail螺钉固定，54例）。两组患者性别、年龄、患膝侧别、致伤原因、Schatzker分型、Tscherne-Gotzen分度、受伤至手术时间及术前外侧胫骨平台后倾角（posterior slope angle，PSA）、胫骨平台内翻角（tibial plateau varus angle，TPVA）、Rasmussen解剖评分等一般资料比较差异无统计学意义（P>0.05）。记录并比较两组患者手术时间、累计透视时间、术中出血量、住院时间、骨折愈合时间及并发症发生情况；术前及术后1年X线片、CT所示PSA、TPVA、Rasmussen解剖评分；记录术后1年两组关节面塌陷例数，采用美国特种外科医院（HSS）评分评价疗效。.
结果: 两组患者均获随访，随访时间12～32个月，平均19.5个月。两组手术时间、累计透视时间、术中出血量、住院时间及骨折愈合时间比较差异均无统计学意义（P>0.05）。研究组和对照组分别有2例（3.7%）和3例（5.8%）患者发生切口浅表感染，经清创换药后愈合，发生率差异无统计学意义（χ2=0.252，P=0.616）。两组患者均未发生血管神经损伤、内固定失效、骨折不愈合或畸形愈合、下肢深静脉血栓形成等并发症。术后1年对照组有9例（17.3%）出现关节面塌陷2～3 mm，而研究组仅出现2例（3.7%），差异有统计学意义（χ2=5.271，P=0.022）。术后1年，两组PSA、TPVA、Rasmussen解剖评分均较术前显著改善（P<0.05）；研究组PSA、TPVA、Rasmussen解剖评分手术前后差值及HSS评分均优于对照组（P<0.05）。.
结论: 外侧排筏钢板结合或不结合Jail螺钉固定治疗累及后外侧柱的胫骨外侧平台塌陷骨折均可获得满意的近期临床疗效，结合Jail螺钉可以增强固定并减少关节面塌陷发生。.
Keywords: Tibial plateau fracture; internal fixation; jail screw technique; lateral raft plate.