累及后柱的SchatzkerⅡ型胫骨平台骨折手术治疗失败的原因分析

目的分析累及后柱的SchatzkerⅡ型胫骨平台骨折手术治疗失败的原因,并根据平台后外侧柱骨折形态学提出相应治疗方案。方法对26例手术治疗失败的累及后柱的SchatzkerⅡ型胫骨平台骨折患者资料进行回顾性分析,对骨折类型、固定方法、骨折形态学特征等因素进行综合评估,分析造成手术失败的可能原因;同时根据影像学资料及形态学特点制定具体手术计划。结果 26例失败患者均伴有严重的膝关节功能障碍,翻修前Rasmussen评分8~17分,HSS膝关节功能评分36~68分。其中手术方法不当8例,内固定方法选择不当18例。翻修术后Rasmussen评分25~28分、HSS评分80~93分,较术前均明显改善(P0.05)。结论骨折复位不良、固定方法选择不当是累及后柱的SchatzkerⅡ型胫骨平台骨折手术失败的主要原因,根据骨折类型及形态学特征制订适当的治疗计划是手术成功的关键。     

复杂胫骨平台骨折的手术治疗

目的：探讨复杂胫骨平台骨折外科治疗的思路和手术方法的选择。方法：72例骨折类型按Schatzker分型，III型lO例，IV型18例，V型28例，VI型16例，均予以手术治疗。单髁空心螺钉固定4例，单侧植骨高尔夫钢板螺钉固定31例，切开复位植骨双侧高尔夫钢板螺钉固定34例，间接复位钢板内固定3例。结果：所有病例无膝关节内外翻现象,5例术后有轻微的胫骨平台再次塌陷。参照Lysholm膝关节功能评分标准，优良率90.28％。结论：根据复杂胫骨平台骨折的特点，合理选择手术方法，在保护骨折部血运的情况下，对胫骨平台进行解剖复位并予以适当的内固定，特别重视对软组织并发症的预防。     

经后内侧入路锁定接骨板固定治疗胫骨平台后侧骨折

目的 探讨经膝关节后内侧入路锁定接骨板固定治疗胫骨平台后侧骨折的临床疗效.方法 对23例胫骨平台后侧骨折患者采用经膝关节后内侧入路显露骨折,行锁定接骨板固定.对2例合并严重前外侧平台骨折者加用前外侧入路予以复位固定;对关节面塌陷者予以自体髂骨植骨.术后早期膝关节康复锻炼.结果 患者切口均一期愈合.1例术后并发腘静脉血栓,予以抗血栓治疗后治愈.无其它并发症发生.患者均获随访,时间12～36个月.术后12个月根据膝关节HSS评分标准评定:优17例,良4例,可2例.结论 对胫骨平台后侧骨折采用后内侧入路、锁定接骨板内固定疗效满意.手术入路的正确选择、关节面骨折的解剖复位、坚强有效的内固定是手术成功的关键.     

微创治疗SchatzkerⅡ型胫骨平台骨折合并膝内侧副韧带损伤

目的对于临床常见的SchatzkerⅡ型胫骨平台骨折合并膝内侧副韧带损伤进行手术治疗,探讨微创治疗的有效、实用方法。方法 11例SchatzkerⅡ型胫骨平台骨折合并膝内侧副韧带损伤采用微创下开窗撬拨植骨结合微创钢板内固定技术（MIPPO）复位固定胫骨平台骨折,双固定螺钉固定膝内侧副韧带损伤,术后支具外固定配合积极康复功能训练。结果本组手术时间50~75 min,平均62 min。11例均获得平均13（5~20）个月随访,膝关节功能良好,无复位不良、感染、骨折不愈合、创伤性关节炎以及膝关节失稳等并发症,术后X线片显示骨折复位固定满意。末次随访时按Rasmussen评分法对膝关节功能进行评估：优7例,良3例,可1例。结论采用微创技术治疗膝外翻应力所致SchatzkerⅡ型胫骨平台骨折合并膝内侧副韧带损伤具有操作简便、固定牢靠、功能恢复良好、治疗效果确切的优点。     

胫骨平台后内髁劈裂骨折的手术治疗

目的:探讨膝关节后内侧入路手术复位内固定治疗胫骨平台后内髁劈裂骨折的临床疗效。方法:2006年1月至2009年7月,采用后侧入路手术治疗胫骨平台后内髁劈裂骨折获得随访的患者21例,男14例,女7例;年龄28～68岁,平均36.9岁。致伤原因:车祸伤14例,高处坠落伤7例。合并伤:合并前交叉韧带损伤15例,均为胫骨平台止点撕脱;合并胫骨平台后外侧塌陷骨折14例。采用膝关节后内侧入路手术复位内固定治疗,术后据Rasmussen膝关节功能评定方法评定疗效。结果:21例均获随访,时间12～30个月,平均17.3个月。无切口感染,无内固定松动及断裂,无骨不愈合,无膝关节内、外翻畸形和骨折再移位。术后后内髁骨折均达解剖复位,1例术后小腿内下方感觉麻木。术后根据Rasmussen膝关节功能评定标准:优12例,良7例,可2例。结论:膝关节后内侧手术治疗胫骨平台后内髁劈裂骨折,有利于平台后内髁骨折的复位和固定,具有暴露清楚、内固定安放方便、创伤小及临床疗效好等优点。     

术前术中外固定架联合单侧锁定接骨板治疗复杂胫骨平台骨折

背景:复杂胫骨平台骨折常会伴随严重的周围软组织损伤。手术治疗可能会加重软组织损伤。目的:探讨手术前及手术中应用外固定架联合单侧锁定接骨板固定治疗复杂胫骨平台骨折的疗效。方法方法:回顾分析2009年6月至2013年10月采用术前术中应用外固定架联合单侧锁定接骨板固定治疗的29例复杂胫骨平台骨折患者。骨折按Schatzker分型:V型12例,Ⅵ型17例;按AO分型:C1型19例,C2型10例。就诊后及早进行闭合复位跨膝关节外固定架固定,软组织条件改善后二期手术中应用外固定架辅助复位,单侧锁定接骨板作最终内固定。结果结果:29例患者术后随访12~24个月,平均16.4个月。患者骨折愈合时间平均为3.7个月,完全负重时间平均为5.1个月。切口因脂肪液化延迟愈合2例,无深部感染病例。根据膝关节Rasmussen评分系统评定疗效:优14例,良11例,中3例,差1例,优良率为86.2%。术后即刻胫骨平台内翻角、胫骨平台后倾角及股胫角与术后1年比较差异均无统计学意义(P>0.05)。结论论:对复杂胫骨平台骨折,术前术中应用外固定架对软组织恢复及骨折复位有明显帮助,单侧锁定接骨板内固定可满足术后早期功能锻炼要求,术后并发症少,疗效满意。     

应用关节镜下胫骨平台定位复位器治疗Schatzker Ⅲ型胫骨平台骨折

目的评价应用关节镜下胫骨平台定位复位器(自行设计,于2015年2月18日获国家实用新型专利,专利号ZL 2 0601629.7)治疗SchatzkerⅢ型胫骨平台骨折的临床疗效。方法2012年3月至2014年6月应用关节镜下胫骨平台定位复位器复位治疗16例SchatzkerⅢ型胫骨平台骨折。本组16例均为闭合骨折,待伤后5~12天局部肿胀消退,软组织条件改善后采用关节镜下胫骨平台定位复位器复位内固定手术治疗。术后1、3、6、12个月规律随访,行膝关节正、侧位X片检查判断骨折愈合情况,并对患者的膝关节功能进行HSS评分[2]。结果 16例获随访6~22个月,平均15个月。HSS评分平均为91.7分,优良率100%,无关节内感染及复位丢失、内固定失败。结论关节镜下胫骨平台定位复位器设计合理,治疗SchatzkerⅢ型胫骨平台骨折复位操作简单、可直视下解剖复位关节面,缩短手术时间,避免其它手术方法造成的软组织损伤、新的骨折及复位不良等副损伤,减少创伤,有助于术后功能康复,是治疗SchatzkerⅢ型胫骨平台骨折较理想的方法,值得推广应用。     

手术治疗胫骨平台骨折失败12例原因分析

目的探讨胫骨平台骨折手术治疗效果不佳的原因。方法回顾1993年2月～2004年3月期间手术治疗的胫骨平台骨折,对其中12例手术治疗效果不佳的原因进行分析。结果本组12例随访8～28个月,平均15个月。其中膝关节外翻、术后过早负重致骨折端移位、内固定松动、膝关节僵硬、感染各1例,关节面塌陷2例,膝关节不稳2例,复位效果不佳3例。结论手术治疗胫骨平台骨折效果不佳的原因有:①手术适应证选择不当,②术前检查不完善,③内固定选择不当,④未充分植骨,⑤术中复位不佳,⑥合并侧副韧带、前后交叉韧带及半月板损伤修复不确实,⑦膝关节锻炼及负重不适度,⑧对开放性骨折清创不彻底。     

后胫骨平台骨折的手术选择

[目的]研究经后内侧及后外侧入路治疗后胫骨平台骨折的手术方法和临床效果。[方法]35例通过后路手术入路治疗后胫骨平台骨折,包括12例后内侧胫骨平台骨折采用后内侧入路,13例后外侧平台骨折采用后外侧入路,10例胫骨平台后内侧及后外侧均骨折采用后内侧加后外侧入路。[结果]患者术后均没有发生切口感染、神经血管损伤、内固定松动及断裂,也没有发生膝内翻、膝外翻畸形及骨折脱位,并且骨折处均已愈合。2例患者术后出现了明显的膝关节屈曲及伸展受限,在经过关节镜下松解手术并辅助以膝关节功能锻炼后得到改善。3例患者术后发生了膝关节创伤性关节炎,在经过向关节腔内注射玻璃酸钠以及口服非甾体抗炎药之后症状明显缓解。[结论]经后内侧及后外侧入路的手术方法有利于后胫骨平台骨折的复位和内固定,而且显露手术视野更清楚、后胫骨平台内固定操作更方便、手术创伤更小。     

空心加压螺钉治疗胫骨平台骨折

目的探讨应用空心加压螺钉治疗胫骨平台骨折的疗效。方法对23例胫骨平台骨折患者施行空心加压螺钉内固定，通过对手术创伤、内固定效果及术后功能恢复情况的观察，探讨该内固定方式的治疗效果。结果23例患者骨折复位良好、内固定牢固，均未发生软组织并发症，膝关节功能恢复良好。结论空心加压螺钉治疗胫骨平台骨折具有创伤小、内固定效果可靠、术后功能恢复良好等优点，是一种理想的内固定方法。     

Reasons for failure of surgical treatment in 25 tibial plateau fractures

BackgroundThe management of tibial plateau fracture is challenging. Restoration of articular congruity and early range of motion should be the primary goal. Proper and adequate preoperative planning is essential for a good outcome.PurposeThe study was a retrospective analysis of failed surgical treatment of tibial plateau fractures.MethodsTwenty-five patients with tibial plateau fractures were referred to our hospital after having undergone surgery elsewhere. Because of functional disability, the patients received revision surgery with concomitant treatment of associated soft tissue injuries. The average age at operation was 43.5 years (range, 27–71 years). The average interval between the first treatment and the secondary operation was 10.4 months (range, 6–24 months). From the radiographs and operative findings, we analyzed the factors that cause failure of the index surgical treatments for tibial plateau fractures.ResultsSchatzker classification identified five type II, one type III, four type IV, seven type V, and eight type VI fractures. Among these 25 cases, nonunion was found in seven (28%) patients and malunion in 18 patients (72%). The causes of failed surgeries included inadequate fixation (76%), malreduction (84%), and bone defect (100%). In addition, there were associated soft tissue injuries in nine patients (36%).ConclusionsThe main elements of the surgical management of tibial plateau fractures are anatomical reduction, firm fixation, and bone grafting. Inadequate fixation, malreduction, and bone defects can lead to the failure of surgical treatment. The key to successful surgical treatment is a well-designed surgical scheme tailored on the specific fracture type and soft tissue condition; this can prevent serious complications and resultant malpractice suits.     

23例SchatzkerⅥ型胫骨平台骨折的手术疗效分析

背景：SchatzkerⅥ型胫骨平台骨折治疗困难,膝关节常遗留严重的并发症,治疗方法尚存争议,多建议双接骨板固定。目的：评价SchatzkerⅥ型胫骨平台骨折的手术疗效。方法：2007年10月至2012年6月手术治疗23例SchatzkerⅥ型胫骨平台骨折。除1例行急诊手术外,其余22例的手术距受伤时间为5～23d,平均7.0d;采用膝前正中切口10例,Y行切口5例,前外侧联合后内侧切口8例;胫骨平台内外侧置锁定接骨板和传统普通接骨板内固定治疗。结果：全部获得随访,随访时间为7～33个月,平均18.3个月。术后骨折愈合时间为6～11个月,平均8.3个月。2例因膝前皮肤坏死行转移皮瓣修复。根据HSS膝关节临床功能评分法评估疗效,优5例,良11例,可4例,差3例。结论：术前充分准备,术中注意保护皮肤软组织和合理内固定,术后科学功能锻炼,SchatzkerⅥ型胫骨平台骨折的手术疗效满意。     

Management of the Schatzker VI fractures with lateral locked screw plating

Complex proximal tibial plateau fractures need surgical treatment to achieve good clinical results. The treatment of this kind of fractures is often complicated either by the patient’s compromised general conditions, or by soft tissue damage. The locking plate combines the technical advantages of an angular stable plate with those of the modern biological plating technique. From December 2002 to December 2008 we treated 18 patients with complex fractures of the tibial plateau (Schatzker VI). All patients were treated with a fixed angle locking plate, 15 with the LISS (Less Invasive Stabilisation System) and 3 with ZPLT (Zimmer Periarticular Locking Plate system). Average time for full weight bearing was 16.2 weeks. In 3 cases we removed the fixation devices after healing because the patients didn’t tolerate the fixation devices. Two patients developed superficial infections that we treated with antibiotic therapy. In 2 cases the LISS plate broke because of pseudarthrosis at the diaphyseal level. To conclude, analysing the results we obtained, we consider that the LISS system is an extremely effective fixation device for the treatment of such difficult and complicated fractures as high energy tibial plateau fractures certainly are. Indirect reduction of the fracture, obtained either with an external fixator, or with traction, must precede the use of the fixation device. The failures, such as post-op malalignment or loss of reduction, are due to a wrong evaluation of the fracture morphology. In fact, comminuted fractures, dislocation and rotation of the medial tibial plateau cannot be stabilised just with lateral angular stable plates, but fixation of the medial tibial plateau must be performed first.     

Timing of internal fixation and effect on Schatzker IV-VI tibial plateau fractures

Objective: To study the effect of internal fixation performed at different times on therapeutic outcomes of Schatzker IV-VI tibial plateau fractures.Methods: The clinical data of 42 cases of Schatzker IV-VI tibial plateau fractures treated in our department were analyzed retrospectively. Among these 42 patients, 21 received surgical treatment within 12 h after injury (Group I), the other 21 were first treated by traction or plaster fixation followed by a delayed internal fixation after soft tissue swelling subsided (Group II). The surgical time, complications, length of hospital stay, cost of hospitalization, and time for fracture union, as well as functional recovery were analyzed and compared between the two groups.Results: After 10-28 months follow-up (mean 16.5 months), except 5 cases who lost to follow-up, no differences were found between the two groups regarding surgical time, preoperative and postoperative complications, healing time or the Hospital for Special Surgery (HSS) score at the end of follow-up, but significant differences were found in the length of hospital stay, cost of hospitalization and HSS score at 3 months after operation (P less than 0.05). Conclusion: Under certain conditions, early internal fixation for Schatzker IV-VI tibial plateau fracture is feasible, which can shorten the length of hospital stay, decrease the cost of hospitalization and promote early functional rehabilitation.     

复杂过伸型胫骨平台骨折的形态特征及手术策略

目的:探讨复杂过伸型胫骨平台骨折的形态特征、手术策略及临床疗效。方法:回顾性分析2017年10月至2019年1月治疗27例复杂过伸型胫骨平台骨折患者资料,男19例,女8例;年龄23~68岁,平均43.4岁。根据胫骨平台骨折Schatzker分型：Ⅳ型8例,Ⅴ型5例,Ⅵ型14例;三柱理论分型：双柱骨折8例,三柱骨折19例...     

胫骨平台骨折合并胫骨结节撕脱性骨折的临床治疗及随访结果

目的分析胫骨平台骨折合并胫骨结节撕脱性骨折的临床治疗及随访结果。方法回顾性分析2010年6月至2012年5月间收治的16例胫骨平台骨折并胫骨结节撕脱性骨折的临床治疗经验,其中4例采用保守治疗,予长管型石膏固定;另12例采用手术治疗,予锁定钢板联合直接钢丝固定。结果按Merchant膝关节功能评分标准:12例手术组患者优6例(50%),良3例(25%),中2例(16.7%),差1例(8.3%),发生术后感染4例(33.3%),深静脉血栓3例(25%);保守治疗组优2例(50%),良1例(25%),中1例(25%),无明显并发症。均获随访,平均18(12~24)个月,末次复查时X线示骨折线消失,均获临床愈合。结论胫骨平台骨折并胫骨结节撕脱性骨折的现代治疗原则倡导注重保护已受伤的软组织,关注生物力学固定与复位,术后负压引流及使用脱水剂,早期膝关节功能锻炼,以期最大程度减少术后并发症。     

股骨转子间骨折术后内固定失效的危险因素研究进展

随着手术技术和内固定材料的发展,股骨转子间骨折的治疗方式不断进步,但是术后内固定失效一直无法避免。对于内固定失效的原因,尚存在争议。目前认为患者高龄、女性和重度骨质疏松使髋部易发生不稳定型骨折,内侧失支撑、股骨颈基底骨折、逆转子间骨折、外侧壁骨折等不稳定型骨折术后内固定位置维持困难,非解剖复位、不合理进钉点、头钉位置不...     

胫骨平台骨折手术疗效影响因素分析

目的探讨胫骨平台骨折手术疗效的影响因素。方法根据Rasmussen膝关节功能评分标准将356例手术治疗的胫骨平台患者分为优良组(n=288)与中差组(n=68),对比两组临床资料,探讨其手术疗效的影响因素。结果两组患者在骨折类型、膝关节周围合并伤、骨折复位情况、术后并发症及术后康复等方面比较差异有统计学意义(P0.01);经多因素Logistic回归分析发现,上述因素均为胫骨平台骨折手术疗效的影响因素(P0.05或P0.01)。结论骨折类型、膝关节周围合并伤、复位情况、术后并发症、术后康复情况均为胫骨平台手术效果的独立影响因素,了解这些影响因素对于胫骨平台骨折患者的临床手术治疗具有重要的指导意义。     

钢板内固定治疗胫骨平台骨折

目的探讨内固定治疗胫骨平台骨折的疗效。方法对65例胫骨平台骨折患者行钢板内固定术。结果 58例获得随访,时间12～15（13.6±1.4）个月。骨折愈合时间2.5～5.2（3.5±1.2）个月。HSS评分85～95分。无一例出现软组织感染坏死,内固定无松动断裂。结论钢板内固定治疗胫骨平台骨折减少了软组织感染的风险,提供了持续的稳定,临床效果满意。但对于并发交叉韧带、内外侧副韧带损伤或合并干骺端骨折的骨折类型仍有其局限性。     

Triple plating of tibia in a complex bicondylar tibial plateau fracture

High-energy tibial plateau fracture poses a significant challenge and difficulty for orthopaedic surgeons. Fracture of tibial plateau involves major weight bearing joint and may alter knee kinematics. Anatomic reconstruction of the proximal tibial articular surfaces, restoration of the limb axis （limb alignment） and stable fixation permitting early joint motion are the goals of the treatment. In cases of complex bicondylar tibial plateau fractures, isolated lateral plating is frequently associated with varus malalignment and better results have been obtained with bilateral plating through dual incisions. However sometimes a complex type of bicondylar tibialplateau fractures is encountered in which medial plateau has a biplaner fracture in posterior coronal plane as well as sagittal plane. In such fractures it is imperative to fix the medial plateau with buttressing in both planes. One such fracture pattern of the proximal tibia managed by triple plating through dual posteromedial and anterolateral incisions is discussed in this case report with emphasis on mechanisms of this type of injury, surgical approach and management.