胫骨平台骨折手术治疗疗效观察

目的探讨手术结合早期功能锻炼及软骨修复药物的综合治疗方案治疗复杂胫骨平台骨折的效果。方法回顾性分析2004年1月至2008年9月治疗并获得随访的复杂胫骨平台骨折41例,按Schatzker分型,Ⅱ型5例,Ⅲ型2例,Ⅳ型3例,Ⅴ型13例,Ⅵ型18例。伤后平均9.4 d手术,术后24 h后开始行CPM膝关节功能训练,并口服氨基葡萄糖类等药物。结果随访时间6～55个月,平均25.1个月,无局部皮肤坏死、伤口感染及内固定钢板松动断裂等。术后2周膝关节屈曲70～°135,°平均100.8;°随访时膝关节屈曲90～°135,°平均121.5;°随访时膝关节HSS评分79～100分,平均88.2分,优（85～100分）28例,良（70～84分）13例。结论复杂胫骨平台骨折应手术复位内固定,结合早期功能锻炼、软骨修复及骨质疏松治疗药物的综合治疗,可获得良好的功能恢复。

Effect of Combined Modality Therapy for Patients with Fractures of Tibial Plateau

Objective Study the effect of combine treatment of surgery,early functional exercise and drug for the patients with complex fractures of tibial plateau.Methods A retrospective analyses was carried out for 41 patients with complex fracture of tibial plateau,which were treated surgically in our hospital from January 2004 to September 2008.According to the Schatzker classification,there were 5 of type Ⅱ,2 of type Ⅲ,3 of type Ⅳ,13 of type Ⅴ,18 of type Ⅵ.Operation were performed from 4 hours to 15 days（mean 9.4 days） after the trauma,functional exercise by CPM were started from 24 hours after the operation,at the same time,glucosamine and other drugs were prescribed to promote the plerosis of cartilage.Results All of the 41 patients were followed up for 25.1 months（range from 6 months to 55 months）.No any complications occurred such as necrosis of incision,infection and loosening or breakage of the internal fixator.The flexion of the knees were 70°～135°（mean 100.8°） at the second week postoperatively;and 90°～135°（mean 121.5°） at the latest follow up.The HSS system score were 79～100（mean 88.2） at the latest follow up.Conclusion In order to achieve satisfactory function recovery,Complex tibial plateau fracture should be treated by open reduce internal fixation,combined with early functional exercise,drugs for cartilage repair and osteoporosis.