摘要
目的探讨胫骨平台骨折畸形愈合的手术治疗,总结临床经验。方法2000年6月～2005年6月,对29例胫骨平台骨折畸形愈合患者行手术重建。男18例,女11例;年龄19～43岁,平均31.6岁。交通事故伤17例,高处坠落伤10例,重物砸伤2例。受伤至就诊时间2.5个月～2年,平均9.7个月。伤后行保守治疗石膏外固定8例;手术治疗21例,其中多枚螺钉固定11例,解剖型钢板、高尔夫钢板或异型钢板固定共8例,外固定支架固定2例。合并前交叉韧带损伤4例,后交叉韧带损伤2例,半月板损伤6例,1例同时合并前、后交叉韧带损伤。手术重新复位固定19例,行胫骨高位截骨术7例,行单侧平台干骺端截骨术3例。结果28例获随访8个月～3年,平均13.6个月。根据Hohl膝关节功能评价方法,按疼痛、主动活动能力及活动范围、稳定性及患者自我评价等5个项目进行综合评分,优8例,良15例,可4例,差1例,优良率82.1%。结论胫骨平台骨折畸形愈合的重建手术,只有严格掌握适应证,并选择合适的术式,才能取得满意的治疗效果。全膝关节置换术只适用于老年患者,对于年轻的患者应尽可能行重建手术。
Objective To explore the treatment of the malunited fracture of the tibial plateau. Methods From June 2000 to June 2005, reconstruction was performed on 29 patients （18 males, 11 females; age, 19-43 years, average, 31.6 years） with the malunited fracture of the tibial plateau. The injury duration ranged from 2.5 months to 2 years, averaged 9.7 months. After the injury, the plaster external fixation was performed on 8 patients and operation was performed on the other 21 patients. The operation was involved in the use of screws in 11 patients, anatomic plates, Golf plates and allotype plates in 8 patients, external fixation braces in 2 patients. A complicating injury to the anterior cruciate ligament （ACL） was found in 4 patients, an injury to the posterior cruciate ligament （PCL） in 2 patients, an injury to both ACL and PCL in 1 patient, and an injury to the meniscus in 6 patients. Reestablishment was performed on 19 patients, high tibial osteotomy on 7 patients, and osteotomy of the half tibial metaphysis on 3 patients. Results Base on the follow-up for 8 months to 3 years（average, 13.6 months）, the comprehensively scoring assessment showed that an excellent result was achieved in 8 patients, good in 15, fair in 4, and poor in 1, with an excellent and good rate of 82. I%, according to the Hohl knee joint function assessment on the pain, active movement, motion range, stability, and self-assessment. Conclusion For the reconstruction of the malunited fracture of the tibial plateau, the satisfactory therapeutic effectiveness can only be achieved if the proper indications are identified and the suitable operative methods are adopted. The total knee replacement is only applicable to the elderly patient, and for the young patient, the reconstruction should be performed.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2007年第10期1031-1035,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
胫骨平台骨折
畸形愈合
手术
适应证
Fracture of tibial plateau Malunion Operation Indication
