复杂胫骨平台骨折的治疗

目的探讨复杂胫骨平台骨折治疗方法及疗效。方法收集2005年3月-2011年3月复杂胫骨平台骨折患者34例，骨折按Schatzker分型：Ⅳ型13例，V型15例，Ⅵ型6例。根据软组织条件、骨折的类型等，所有病例择期手术治疗，手术最好在损伤后5～10天，双侧钢板螺钉内固定16例，单侧钢板螺钉内固定18例，并进行阶段性的康复指导。结果34例患者无关节感染，术后随访平均14．6个月，骨折愈合时间平均5．8个月，膝关节HOHL临床评分法评定疗效：优20例，良9例，可4例，差1例，优良率为85．3％。结论复杂胫骨平台骨折治疗困难，正确评估软组织损伤的程度和骨折分型、保护骨折的生物学环境、可靠的内固定和充分植骨以及有效的功能活动是提高疗效的关键。

Treatment methods and its curative effect for the complex fracture of tibial plateau

Objective To evaluate the clinical efficacy for the complex fracture of tibial plateau.Methods 34 patients with complex fractures of tibial plateau from March 2005 to March 2011 were treated and according to the Schatzker classification,13 cases were Ⅳ type,15 type Ⅴ and 6 type Ⅵ.According to the condition of the soft tissue and the type of fracture all cases were operated treatment by selecting time.The best operation times of the fracture of tibial plateau were 5 to 10 days after injury.Bilateral incisions and dual plating were adopted in 16 cases,18 cases were fixed by plating at one side.All cases should be directed periodic rehabilitation.Results All patients were followed up for a mean duration average of 14.6 months.Bone union was observed in all cases after an average of 5.8 months with noninfection.According to HOHL scoring,the knee functions were excellent in 20,good in 9,fare in4 and poor in The excellent to good rate was 85.3％.Concltsion The treatment for the complex fracture of tibial plateau was difficult.It was the key to correct judgment of the injury of soft tissue and the types of fractures,and provide protection for biomechanical performance of fractures with a good internal fixation,effective bone graft,and strict postoperative rehabilitation.