内固定治疗的胫骨平台骨折

目的总结胫骨平台骨折的内固定治疗方法。方法2001-05~2005-12,收治胫骨平台骨折患者23例,男17例,女16例。年龄32~59岁,平均41.6岁。按schaztker分类标准对胫骨平台骨折进行分型:Ⅰ型5例、Ⅱ型12例、Ⅲ型2例、Ⅳ型2例、Ⅴ型1例、Ⅵ型1例,均行手术治疗。根据分型行内侧或外侧纵切口,用松质骨螺丝钉、T型或L型钢板内固定,16例病人因骨质压缩行髂骨取骨植骨、1例骨损缺量小,行股骨外上髁取骨植骨术。Ⅰ型中2例合并外侧半月板损伤,1例手术同时修补,1例损伤严重切除;Ⅱ型中4例合并内侧副韧带损伤,保守治疗良好。结果23例病人中,17例获随访。随访时间1~3年,平均1年2个月。骨折均愈合,愈合时间Ⅰ、Ⅱ、Ⅲ型均为3个月内,Ⅵ型1例超过6个月,同时合并ACL断裂,术后1年行关节镜下ACL重建,现患膝关节残存轻度功能障碍。结论胫骨平台骨折的治疗需根据患者情况决定治疗方案,虽然schctzkerⅤ、Ⅵ型内固定术后效果欠佳,尤其合并多个组织损伤时,但切开复位内固定,仍是一种有效的治疗方案。术后可能出现膝关节强直、创伤性关节炎、骨折不愈合、感染等并发症。但手术后早期和全面康复训练直接影响到治疗效果。

Internal Fixation of Tibial Platform Fracture

Objective To discuss the internal fixation of tibial platform fracture.Methods 23 cases of such patient(male 17 cases,female 16 cases) with age of 32～59 in 41.6 average from May 2001 from December 12 were underwent internal fixation.They were divided into type Ⅰ 5 cases,type Ⅱ 12 cases,type Ⅲ 2 cases,type Ⅳ 2 cases,type Ⅴ 1 case and type Ⅵ 1 case according to schaztker classification standard.All cases were performed with screw,T or L steel plate and bone transplantation.There were 4 cases of type Ⅱ were performed with conservative method.Results 17 cases were followed up 1～3 years(14 months in average).All fracture were healed.The healing time were within 3 months in type Ⅰ,Ⅱ,Ⅲ,and over 6 months in type Ⅵ which was ACL reconstructed with arthroscope.There was slight dysfuction of knee joint.Conclusion The treatment of tibial platform fracture should be performed according to varied situation and internal fixation should be effective though there might be just so effect with type Ⅴ and Ⅵ.The rigidity,traumatic arthritis,un-union and infection might be complication.The early treatment and total rehab might be good for curative effect.