胫骨平台骨折的手术治疗策略

目的探讨胫骨平台骨折外科治疗的思路和手术方法的选择。方法自2000年6月～2003年9月共收治胫骨平台骨折207例(陈旧性损伤不统计在内)，男129例，女78例，共212个胫骨平台骨折(5例为双侧骨折)。闭合性损伤165侧，开放性损伤47侧。按Schatzker分类并予以分别行非手术治疗19例、单髁空心螺钉固定24例、单侧植骨并高尔夫钢板螺钉固定116例、切开复位植骨双侧高尔夫钢板螺钉固定37例、经皮间接复位钢板内固定11例。结果根据Hohl膝关节功能平分法进行综合平分：优149例，良29例，可20例，差16例。结论根据胫骨平台骨折的特点而选择不同的手术方法，在首先保护骨折部血运的情况下，对胫骨平台进行解剖复位并予以适当的内固定，以及手术后积极的无负重下膝关节功能训练是获得良好手术效果的关键。

The Key to Surgical Treatment of Tibial Plateau

Objective To explore the option of the surgical treatment of tibial plateau.Methods From June 2000 to September 2003,207 patients (212 side of tibial plateaus,including 5 cases of bilateral tibial plateau fracture)with tibial plateau fracture were followed(the old fracture were excluded).The closed fracture were 165 cases,and the open were 47.All the cases were classified by Schatzker standard,and treated respectively with conservative method in 19 cases,unilateral condylar cannulaed nail fixation was 24 cases,unilateral internal fixation with Golf plate and bone implant 116 cases,internal fixation with double Golf plates and bone implant 37 cases,indirect reduction and fixed with plate percutaneus 11 cases.Results The results were estimated according to Hohl knee functional rules.The excellent were 149 cases,the good 29 cases,the common 20 cases,the bad 16 cases.Conclusion The key to the satisfited results of the surgical treatment of tibial plateau fractures are as follow as,to make individual operation according to the character of the tibial plateau fracture,the reduction of the articular surfaces should be subjective to the protect of the regional blood supply,and the proper physical exercises without weight bearing.