摘要
目的探讨手术治疗复杂胫骨平台骨折,即SchatzkerⅣ型、V型、Ⅵ型骨折的疗效。方法对36例复杂胫骨平台骨折行手术切口复位内固定治疗。其中开放性损伤中2例闭合性损伤中7例先给予抗感染脱水治疗后行二期手术,其余27例均行急诊手术。手术入路根据骨折的情况选择前内侧切口、前外侧切口,或者前外侧联合内侧切口。术中整复关节面,骨缺损者给予自体植骨,并予T型或L型钢板固定。术后早期CMP锻炼,待影像学提示骨性愈合后逐渐负重锻炼。结果本组病例中2例因为搬迁而未获随访,其余均获得随访。随访时间8～23个月。采用Merchant标准综合评分,优21例,良9例,可4例,差2例,优良率为83.3%。结论复杂胫骨平台骨折是严重的关节内骨折,必须通过术前影像学检查详细了解骨折情况,以制定最佳的手术计划,术中尽量达到解剖复位,足量植骨,坚强内固定,术后恰当的锻炼是取得最佳疗效的关键。
Objective To explore the treatment of operation for complex fractures of the tibial plateau.Methods The effect of 36 cases with complex fractures of the tibial plateau for operative treatment was analyzed.2 cases of open injury and the seven cases of close injury were given antibiotics before the second phase dehydration therapy underwent surgery,and the remaining 27 patients underwent emergency surgery.According to different fractures,we chose right surgical approach,including the medial incision,anterolateral incision,or incision anterolateral joint inside.In surgeries,we restore articular surface,graft autologous bone for bone defect,use T or L plate to fix.Encourage patient use CMP to exercise early after operations.Weight-bearing exercise gradually when the imaging to imply bone healing.Results 2 cases of the patients because of the relocation have not been followed up,the rest were followed for 8—23 month.According to Merchant＇standard,excellent： 21 cases,good： 9 cases;poor： 4 cases,bad： 2 case,The total percentage of good to excellent clinical results was 83.3%.Conclusion Complex fractures of the tibial plateau is serous intra-articular fracture,we must learn more about the fracture by the different images so that best surgical plan can be made.The keys of the best effect are anatomical reduction as much as possible,bone grafting adequately,right exercise.
出处
《西部医学》
2011年第8期1472-1473,1475,共3页
Medical Journal of West China
关键词
胫骨平台骨折
复杂型
手术治疗
Tibial plateau fractures
Complex style
Surgery
