胫骨平台骨折的手术治疗

目的提出一种新的内固定思路,并以此指导胫骨平台骨折的手术治疗,探讨其疗效。方法研究胫骨平台的解剖特点和胫骨平台骨折的大量资料,将胫骨平台分为前内、前外、后内、后外四个柱,选择1～2个明显移位或不稳定的柱予以支撑钢板固定,其余的柱通过支撑钢板的螺钉间接固定来达到整个胫骨平台的稳定。2005年1月至2009年1月间以此指导手术治疗胫骨平台骨折78例。结果 78例患者术后平均随访时间21个月（12～36个月）,骨折X线愈合时间平均为11.1周,完全负重时间平均为11.3周（10～18周）。术后1年膝关节HSS临床功能评分平均87.1分（65～98分）,优良率为92.3%。术后即刻与术后1年胫骨平台内翻角和胫骨平台后倾角度数比较,差异均无统计学意义（P〉0.05）。结论胫骨平台四柱划分思路有助于骨折内固定的选择,减少术后胫骨平台二期塌陷、移位及力线不良等并发症,但因病例数有限,这种内固定方法还有待进一步检验和完善。

A New Classification Scheme and Treatment Strategies of Tibial Plateau Fractures

Objective To introduce a new scheme for surgical treatments of tibial plateau fractures and to explore its efficacy.Methods A new scheme was developed based on an analysis of radiographic data of cases with tibial plateau fractures,according to this scheme,the total tibial plateau was divided into four columns：（anteromedial,anterolateral,posteromedial and posterolateral column）.To maintain the stability of the total tibial plateau,one or two obviously displaced or unstable columns were fixed with buttress plates,and the remaining columns were indirectly stabilized by the screws passed the buttress plates to achieve stabilization.78 cases with tibial plateau fractures were operatively treated under the guideline of this scheme from January 2005 to January 2009.Results All patients were followed-up for an average of 21 months（range：12～36 months）.The mean full weight-bearing time and radiographic bone union time were 11.3 and 11.1 weeks respectively,the mean HSS score one year after operation was 87.1 points（range：65～98 points） with an excellent rate of 92.3%.In all patients,no significant differences was found in TPA and PA between immediately postoperatively and one year later.Conclusion ＂Four columns scheme＂ is helpful for tibial plateau fractures in determining implants,reducing such complications as secondary displacements and malalignments,however,due to our limited cases,the further verification of the validity of this scheme in guiding treatments is still needed to supplement by biomechanical test and clinical application.