胫骨内侧平台骨折手术治疗失败的原因分析

目的 分析胫骨内侧平台骨折手术治疗失败的原因，并为内侧平台骨折提出具体分型，以指导治疗，减少并发症。方法对1998年6月～2004年9月间手术治疗失败的17例胫骨内侧平台骨折进行回顾性分析，对骨折类型、固定方法、骨折复位质量及术后康复等因素进行综合评估，分析造成手术失败的可能原因；同时根据内侧平台骨折的影像学资料及临床特点进行具体分型。结果17例失败患者伴有严重的膝关节功能障碍，HSS膝关节功能评分平均为41分（24～54分）。手术治疗失败原因：手术方法不当4例，固定方法选择不当11例，术后康复治疗错误2例。结论骨折复位不良、固定方法选择不当、对软组织情况及肢体力线缺乏足够的认识与重视及术后错误的康复治疗均是胫骨内侧平台骨折手术失败的原因，根据具体的骨折类型及软组织条件制订适当的治疗计划是手术成功的关键。

Analysis of failed surgical treatments of the medial tibial plateau fractures

Objective To analyze causes for failed surgical treatments of medial tibial plateau fractures, and to suggest a new classification system for medial tibial plateau fractures which can result in better treatment and decreased complications.Methods Seventeen cases underwent failed surgical treatments for their medial tibial plateau fractures from June 1998 to September 2004.They were retrospectively analyzed.Factors,including fracture pattern,fixation method,quality of reduction and postoperative rehabilitation,were evaluated to find the possible causes.Moreover,the medial plateau fractures were classified into subtypes based on the imaging data and clinical characteristics.Results All the cases presented severe functional impairment with a mean HSS (Hospital for Special Surgery)score of 41 points(range,24 to 54 points).Improper surgical technique was found to be re- sponsible for failure in four cases;improper fixation methods in 11 cases;incorrect postoperative rehabilitation in two cases.Conclusions Malreduction,improper fixation,neglect of soft tissue conditions or limb alignment,and incorrect rehabilitation can lead to failure of surgical treatment.The key to successful surgical treatment is a well-designed treatment scheme based on the specific fracture subtype and soft tissue condition.