胫骨平台伴髁间嵴骨折手术治疗的临床疗效

目的：探讨开放复位内固定治疗胫骨平台伴髁间嵴骨折的临床疗效。方法2007年6月～2011年6月对收治的42例胫骨平台伴髁间嵴骨折采用切开复位钢板内固定治疗，同时行钢丝固定髁间嵴骨折36例，6例未固定。胫骨平台骨折按Schatzker分型：Ⅲ型8例，Ⅳ型18例，Ⅴ型10例，Ⅵ型6例；胫骨髁间嵴骨折按Meyers McKeever分型：Ⅰ型6例，Ⅱ型17例，Ⅲ型13例，Ⅳ型6例。结果术后1例切口发生脂肪液化并感染，经清创、负压吸引及II期缝合后愈合，余伤口均Ⅰ期愈合。随访12～26个月，平均18个月。末次随访时，患者膝关节伸直均达到0°，屈膝80°～150°，平均122°；膝关节稳定性检查：3例Lachman试验及前抽屉试验（ ADT）为阳性；参照Rasmussen膝关节功能评分标准：优16例，良19例，可4例，差3例；优良率为83.3％。7例发生膝关节创伤性关节炎，3例胫骨髁间嵴骨折未愈合。结论手术治疗胫骨平台伴髁间嵴骨折应重视对髁间嵴骨折的固定，包括无移位的髁间嵴骨折，有利于术后早期功能锻炼及维持膝关节稳定。

Clinical effect of operative treatment on tibial plateau and intercondylar eminence fracture

Objective To investigate the clinical efficacy of open reduction and internal fixation in the treatment of tibial plateau and intercondylar eminence fracture .Methods Between Jun.2007 and Jun.2011,42 cases of tibial plateau and intercondylar eminence fracture were treated by open reduction and internal fixation . Meanwhile,steel wire fixation was used for fracture of tibial intercondylar eminence in 36 cases.According to the Schatzker classification of tibial plateau fracture ,there were 8 cases of type Ⅲ,18 cases of type Ⅳ,10 cases of typeⅤ,6 cases of type Ⅵ.According to the Meyers McKeever classification of tibial intercondylar eminence fracture , there were 6 cases of type Ⅰ,17 cases of type Ⅱ,13 cases of type Ⅲ,6 cases of type Ⅳ.Results Primary heal-ing was achieved in all cases except 1 case of postoperative incision with fat liquefaction and infection , who was cured by debridement ,vacuum aspiration and suture in the secondary stage .All cases were followed up for 12-26 months （mean 18 months）.At the last follow-up,the extension of knee joint was 0°and the flexion of knee joint was 80 °-150 °（mean, 122 °）.Lachman test and ADT test of knee joint stability indicated positive in 3 cases.Ac-cording to the Rasmussen scoring system ,there were 16 cases of excellent , 19 cases of good , 4 cases of fair and 3 cases of poor .The excellent and good rate was 83.3%.Traumatic osteoarthritis in knee joint occurred in 7 cases and nonunion of tibial intercondylar eminence fracture occurred in 3 cases.Conclusion During the operative treat-ment of tibial plateau and intercondylar eminence fracture ,attention should be paid to the fixation for intercondylar eminence fracture , including non-displaced fracture of tibial intercondylar eminence , which allows early exercise af-ter operation and maintains the stability of knee joint .