摘要
目的 总结胫骨平台骨折的临床特征和治疗方法。方法 手术治疗胫骨平台骨折 186例 (189处 ) ,根据骨折类型并结合主骨折块与塌陷部位选择切口显露及有限切开部位 ,术中单纯空心钉、松质骨螺钉或螺栓固定 5 1处 ,T型、L型或曲棍球棒形支撑钢板固定 89处 ,复合固定包括曲棍球棒形支撑钢板加T板、L板或松质骨拉力螺钉固定 4 9处 ;骨折压缩部位复位后的骨缺损应用髂骨或人工骨植骨 10 1处。结果 178例获得随访 ,骨折均在 12周内愈合 ,采用Rasmussen评分标准评定临床疗效 ,结果优 96例 ,良 6 8例 ,可 11例 ,差 3例 ,优良率 92 %。结论 胫骨平台骨折的手术治疗需依据骨折类型 ,遵循分期治疗原则 ,满意的疗效取决于 :①关节面平整、下肢力线和关节韧带连续性的恢复 ;②骨折压缩部位复位后骨缺损必须植骨支撑 ;③能满足早期功能锻炼的有效内固定 ;④妥善处理软组织包括关节韧带、半月板损伤 ;⑤适时早期功能锻炼。
Objective To explore the clinical features and surgical techniques of the tibial plateau fractures.Methods From February 1998 to August 2000,186 patients with tibial plateau fractures were treated in our hospital,which were 135 males and 51 females with the average age of 47.7 years ranging from 20 to 64 years.According to Schatzkers classification,the fractures were diagnosed as type Ⅰ in 12,type Ⅱ in 78,type Ⅲ in 28,type Ⅳ in 21,type Ⅴ in 37 and type Ⅵ in 13.Approaches depended on the classification and the site of large fragment or depressed articular surface.Internal fixation was achieved using screws in 51,Tshape,Lshape plate or reconstruction plate in 89 and combined fixation in 49.Bone grafting was assisted beneath the depressed articular surface after reduction in 101.Results Of 186 patients,178 were followed up from 42 to 68 months (average 56.3 months).All fractures were united within 12 weeks postoperatively.According to Rasmussens 30-point knee rating system,96 patients were excellent,68 good,11 fair and 3 poor.The excellent and good rate was 92%.Conclusion Tibial plateau fractures should be treated according to the classification and stage.To ensure excellent clinical results should be based on following factors,①excellent restoration of articular surface and mechanical axis;②bone grafting beneath depressed areas;③sufficient internal fixation;④repairing all stable structure of the knee;⑤early knee mobilization.
出处
《骨与关节损伤杂志》
2004年第12期809-811,共3页
The Journal of Bone and Joint Injury
