【摘要】 [目的]比较三种锁定钢板治疗胫骨外侧平台骨折的临床疗效。[方法]回顾性分析2019年2月—2024年2月本科开放复位内固定治疗的57例胫骨外侧平台骨折患者的资料。其中，2021年6月前的36例采用传统前外侧锁定钛板固定（传统组）；2021年6月后，对累及后外侧象限，但后外侧壁未破裂的6例采用新型四钉锁定钛板固定（四钉组），而外侧壁破裂者的15例采用新型五钉锁定钛板固定（五钉组）。比较三组围手术期、随访及影像资料。[结果]所有患者均顺利完成手术，术中无神经血管损伤等并发症。三组患者手术时间、切口长度、术中透视次数、术中失血量及住院时间的差异均无统计学意义（P>0.05）。患者均获随访，随访时间平均（30.8±14.6）个月。与术后3个月相比，末次随访时三组患者VAS评分显著降低（P<0.05）,Rasmussen临床评分和膝伸-屈ROM均显著增加（P<0.05），相应时间点三组间上述指标的差异均无统计意义（P>0.05）。影像方面，最前端螺钉弧度新型五钉组<传统钢板组<新型四钉组，差异有统计学意义[°,(44.5±5.9) vs(51.6±7.0) vs(58.3±8.0), P<0.001]；最后端螺钉弧度新型四钉组和新型五钉组均显著大于传统钛板组[°,(112.2±5.1) vs(115.8±13.9) vs(96.1±7.6), P<0.001]。螺钉覆盖弧度新型五钉组>新型四钉组>传统钢板组，差异均有统计学意义[°,(71.3±12.3) vs(54.0±10.3) vs(44.5±6.0), P<0.001]。术后即刻Rasmussen评分新型五钉组<传统钢板组<新型四钉组，差异均有统计学意义[分,(13.8±1.4) vs(15.1±1.8) vs(17.7±0.8), P<0.001]，末次随访Rasmussen影像评分新型四钉组显著优于传统钢板组[分,(17.3±1.0) vs(15.5±1.8), P<0.001]。[结论]腓骨头上入路新型锁定钛板较前外侧入路传统锁定钛板固定范围更大，固定更为牢靠，操作难度未增加，但放置时需避免钛板被动前移，顶端尽量固定5枚螺钉。更多还原

【Abstract】 [Objective] To compare the clinical consequences of three types of locking plates for fixation of lateral tibial plateau fractures(LTPFs). [Methods] A retrospective research was conducted on 57 patients who had LTPFs treated with open reduction and internal fixation(ORIF) in our department from February 2019 to February 2024. Of them, 36 patients who received ORIF before June 2021 were with traditional anterolateral locking titanium plates(the traditional group); while the 6 patients who suffered from LTPFs involving the posterolateral quadrant without posterolateral wall fractures were treated with the new-type four-screw locking titanium plate(the four-screw group), 15 patients who had LTPFs involving the posterolateral quadrant with posterolateral wall fractures were treated with the new-type five-screw locking titanium plate(the five-screw group). The perioperative, follow-up and imaging data of the three groups were compared. [Results] All patients in the three groups had corresponding ORIF performed successfully without serious complications, such as nerve and vascular injury during the operation. There were no statistically significant differences in terms of operation time, incision length, intraoperative fluoroscopy times, intraoperative blood loss and hospital stay among the three groups(P>0.05). All patients in the three groups were followed up for an average of(30.8±14.6) months. The VAS score was significantly reduced in the three groups(P<0.05), while the Rasmussen clinical score and knee flexion-extension range of motion(ROM) were significantly increased at the last follow-up compared with those 3 months postoperatively(P<0.05). However, there were no statistically significant differences in the abovesaid items among the three groups at any corresponding time points(P>0.05). Regarding imaging, the arc of the most anterior screw in the five-screw group was smaller than that in the traditional plate group and the four-screw group [°,(44.5±5.9) vs(51.6±7.0) vs(58.3±8.0), P<0.001]; the arc of the most posterior screw in the four-screw group and the five-screw group was significantly larger than that in the traditional plate group [°,(112.2±5.1) vs(115.8±13.9) vs(96.1±7.6), P<0.001]. The arc of screw coverage in the five-screw group was larger than that in the four-screw group and the traditional plate group [°,(71.3±12.3) vs(54.0±10.3) vs(44.5±6.0), P<0.001]. The Rasmussen imaging score immediately after surgery in the five-screw group was lower than that in the traditional plate group and the four-screw group [score,(13.8±1.4) vs(15.1±1.8) vs(17.7±0.8), P<0.001], while which in the fourscrew group was significantly better than that in the traditional plate group at the last follow-up [score,(17.3±1.0) vs(15.5±1.8), P<0.001].[Conclusion] This new-type locking titanium plate through the fibular head approach with larger fixation rangeis more reliable than the traditional anterolateral locking titanium plate, without increasing the operation difficulty. However, when placing the plate, passive anterior displacement of the titanium plate should be avoided, and five screws should be fixed at the top as much as possible.更多还原