高能量胫骨平台骨折的处置

[目的]探讨高能量胫骨平台骨折的处置。[方法]本组对1998年1月～2003年6月收治高能量胫骨平台骨折46例的处理进行回顾性研究。[结果]43例术后随访1～4a，膝关节功能均基本恢复，据Merchant标准评分，优良率82．4％。[结论]高能量胫骨平台骨折应重视围手术期综合处理。术前对骨折的复杂程度及合并伤正确评估；术中必须考虑骨损伤和伴有软组织损害，如果不能进行完全切开复位内固定，可采取有限切开、间接复位、杂合固定，力求恢复关节功能，尽量维持正常的力轴线，确保关节稳定，术后早期密切观察患肢情况，加强膝关节早期功能锻炼，采取综合有效的对策，可使受损的膝关节功能达到最大程度恢复。

Management of high-energy fractures of tibial plateau

[Objective]To investigate the treatment for high-energy fractures of tibial plateau. [Method]Fourty-six cases of high-energy fractures of tibial plateau treated since January 1998 to June 2003 were studied retrospectively.[Results]Forty-three cases were followed-up for one to four years postoperatively. Knee function recovered generally in all cases. According to Merchant classification, the satisfactory rate was 82.4 %. [Conclusion]Perioperative management of the high-energy fractures of tibial plateau must be emphasized as following: The complications of fracture must be evaluated exactly preoperatively. During the operation, not only the bony injury but also the associated soft tissue damage should be considered. If open reduction and internal fixation couldn't be fulfilled, limited open incision, indirect reduction and hybrid fixation strived to restore joint congruity should be taken, the normal mechanical axis should be maintained to ensure knee joint stability , and to restore a full range of motion. The state of injurd limbs must be observed closely postoperatively, early-stage knee functional exercise should be started, various effective methods can be taken to recover the injured knee function to the best level if possible.