胫骨平台复杂骨折32例治疗分析

目的探讨胫骨平台复杂骨折的处置。方法本组对2004年6月～2007年12月收治高能量胫骨平台骨折32例的处理进行回顾性研究。结果32例患者术后获12～24个月（平均17．4个月）随访,骨折均获愈合。术后即刻Rasmussen评分平均为16．8分,术后12个月膝关节HSS评分平均为85．4分（68～95分）,优良率为90．9％。术后12个月膝关节活动度平均为1.8°～122．3°。术后2例患者出现切口裂开,无螺钉松动、断裂及内固定失败等其它并发症发生。结论复杂胫骨平台骨折应重视围手术期综合处理。术前对骨折的复杂程度及合并伤正确评估,根据每个骨折的特点及软组织情况选择合适的固定方式,加强膝关节早期功能锻炼,采取综合有效的对策,可使受损的膝关节功能达到最大程度恢复。

Analysis of Treatment in 32 Patients with Complicated Fracture of Tibial Plateau

Objective To investigate the treatment for complicated fracture of tibial plateau. Methods Thrity-two cases of complicated fractures of tibial plateau treated since June 2004 to December 2007 were studied retrospectively. Results All were followed up for an average of 17. 4 months （range, 12 to 24 months）. All of fracture obtained healing. The mean HSS score of all the patients at 12 months postoperatively was 85.4 （ range, 68 to 95 ）. The average ROM of the affected knee joints was 1.8° to 122.3° . Two wound dehiscence. No screw sliding, dislodging or fixation failure was found during follow-up. Conclusion Perioperative management of the complicated fractures of tibial plateau must be emphasized as following. The complications of fracture must be evaluated exactly preoperatively. Treatment strategies of dealing with associated injuries, accurate diagnosis, and selection of individualized method for reduction and fixation are emphasized. Early-stage knee functional exercise should be started, various effective methods can be taken to recover the injured knee function to the best level if possible.