复杂性胫骨平台骨折手术技巧探讨

目的探讨复杂性胫骨平台骨折的手术治疗方法。方法复杂性胫骨平台骨折12例,均行切开复位、钢板内固定,骨缺损者同时予以植骨。术中首先在持续牵引下矫正肢体力线,以股骨髁、残留的平台关节面为参照,用骨刀将关节面复位并尽量恢复关节面的平整,然后逐渐加大牵引重量使膝关节间隙略增大,将关节面再次抬高2~3 mm,缺损区域充分植骨,术中及术后保持外翻角5~8°固定。结果12例术中复位良好,未发生伤口感染或皮肤坏死。随访6个月至3年,均骨性愈合,平均愈合时间6.8个月,无内固定物松动。术后功能评价优7例,良3例,可1例,差1例,优良率83.3%。结论复杂胫骨平台骨折术前应准确评估软组织条件,手术方法根据不同的骨折类型而异;术中应兼顾骨折和软组织条件;术后早期功能锻炼。

Surgical management of complex fractures of tibial plateau

Objective To discuss the surgical techniques for treatment of high energy fractures of the tibial plateau.Methods Twelve cases of high energy fractures of the tibial plateau treated since January 2001 to January 2006 were studied retrospectively.All patients were treated by open reduction,plate internal fixation and bone graft if bone defect existed.For those with severe articular fracture,we used the femoral condyle and residual articular surface as the reference to reduce the articular surface.After reduction,we attempted to increase the articular space by 2~3 mm by persistent bony traction.The limb maintained an everted position with the valgus degree of 5~8.Results All patients were followed-up for 6 months to 3 years postoperatively.The mean bone union time was 6.8months.Knee function recovered generally in all cases.The satisfactory rate was 83.3%.Conclusion The choice of operative measures for complex fractures of the tibial plateau depends on the conditions of the bony and soft tissue damages.The normal mechanical axis should be maintained to ensure the knee joint stability,and to restore a full range of motion.Early postoperative functional exercise is recommended.