胫骨平台骨折196例手术治疗分析

目的总结胫骨平台骨折的临床特征和治疗方法。方法手术治疗胫骨平台骨折196例(199处),根据骨折类型并结合主骨折块与塌陷部位选择切口显露及有限切开部位,术中单纯空心钉、松质骨螺钉或螺栓固定56处,T型、L型或曲棍球棒形支撑钢板固定94处。复合固定包括曲棍球棒形支撑钢板加T板、L板或松质骨拉力螺钉固定41处;骨折压缩部位复位后的骨缺损应用髂骨或人工骨植骨101处。结果196例获得随访,骨折均在12周内愈合,优107例、良76例、可10例、差3例,优良率93%。结论胫骨平台骨折的手术治疗需依据骨折类型,遵循分期治疗原则,满意的疗效取决于:①关节面平整、下肢力线和关节韧带连续性的恢复;②骨折压缩部位复位后骨缺损必须植骨支撑;③能满足早期功能锻炼的有效内固定;④妥善处理软组织包括关节韧带、半月板损伤;⑤适时早期功能锻炼。

Operative treatment of 196 patients with tibial plateau fractures

Objective To explore the clinical features and surgical techniques of the tibial plateau fractures.Methods From February 1998 to August 2004,196 patients with tibial plateau fractures were treated in our hospital,which were 140 males and 56 females with the average age of 47.5 years ranging from 20 to 65 years.According to Schatzker's classification, the fractures were diagnosed as type Ⅰin 12,type Ⅱin 81,type Ⅲ in 30,type Ⅳ in 22,type Ⅴ in 38 and type Ⅵ in 13.Approaches depended on the classification and the site of large fragment or depressed articular surface.Internal fixation was achieved osing screws in 56,T-shape,L-shape plat or reconstruction plate in 94 and combined fixation in 51.Bone grafting was assisted beneath the depressed articular surface after reduction in 101.Results 196 patients were followed up from 42 to 68 months(average 56.3 months).All fractures were united within 12 weeks postoperatively.According to Rasmussen's 30-point knee rating system,107 patients were excellent,76 good,11 fair and 3 poor.The excellent and good rate was 93%.Conclusion Tibial plateau frachures should be treated according to the classification and stage.To ensure excellent clinical results should be based on following factors,①excellent restoration of articular surface and mechanical axis,②bone grafting beneath areas,③sufficient internal fixation,④repairing all stable structure of the knee,⑤early knee mobilization.