胫骨平台骨折的现代治疗探讨

目的总结近年来治疗胫骨平台骨折的经验教训，为临床选择更好的治疗方法、提高胫骨平台骨折手术疗效提供参考。方法回顾分析自2001-2007年收治的胫骨平台骨折89例，其中按照Schatzker分型复杂胫骨平台骨折（Ⅴ型，Ⅵ型）67例，男性75例，女性14例。均行切开复位，严格按照内固定原则分别采用螺丝钉和／或外固定架、钢板、微创内固定系统固定骨折进行治疗，必要时辅以关节镜探查镜下手术。结果75例得到随访，最短6个月，最长6年，平均31个月。骨折均愈合，疗效评定参照Merchant标准，术后6个月优良率为81．6％，术后1年优良率为89．3％。结论胫骨平台骨折应当考虑手术治疗，周密的术前计划、妥善处理软组织损伤、正确选择切口、灵活应用内外固定物及关节镜辅助均是手术成功的重要因素。

Discuss of modern treatment of tibial plateau fracture

Objective To summarize the therapeutic experiences and lessons oftibial plateau fractures in recent years, to select better treatments and improve the clinical results of operations. Methods 89 patients with fractures of tibial plateau were treated in our hospital from 2001 to 2007,male 75,female 14.According to Schatzker＇s classification, 67 patients belonged to complicated fractures（type Ⅴ, type Ⅵ）.Patients were operated and fixation was achieved with screws, steel plates,less invasively stabilization systems（LISS）, external fixation and hybrid fixation respectively.Some of them got arthroscopic operations. Results 75 patients were followed up.The average length of followed-up were 31 months （range 6 months to 6 years）.Fractures healed in all the patients.Based on Merchant criteria,the recovery of knee joint functiom were excellent in 81.6% of the patients 6 months and in 89.3% of the patients 1 year after operation. Conclusion It is highly recommended that open reduction and internal fixation are performed in the treatment of complicated fractures of tibial plateau.Careful planning preoperatively, correct treatment of soft tissue injury, chioce of incision,internal fixator and external fixator, arthroscopy should be chosen for successful operation according to particular conditions of the patients.