有限切开间接复位治疗胫骨平台骨折

Limited exposure and indirect reduction in tibial plateau fractures

目的探讨有限切开间接复位治疗胫骨平台骨折的临床效果。方法采用有限切开间接复位治疗胫骨平台骨折41例,采用Schatzker分型:Ⅰ型6例,Ⅱ型13例,Ⅲ型11例,Ⅳ型6例,Ⅴ型3例,Ⅵ型2例。Ⅰ型骨折用点状复位钳闭合复位,经皮拉力螺钉固定。Ⅱ、Ⅲ、Ⅳ型骨折恢复关节面平整后植骨,点状复位钳复位,经皮支撑钢板固定;Ⅴ、Ⅵ型用骨折牵开器及点状复位钳间接复位,经皮支撑钢板固定。结果36例获得随访,随访6～60个月,平均30.2个月。36例全部获得骨折愈合,膝关节功能按Rasmussen评分标准,优25例,良8例,可3例,优良率为91%。结论应用有限切开间接复位治疗胫骨平台骨折,创伤小,固定牢靠,可早期功能锻炼,关节功能恢复好,并发症少。

Objective To investigate the clinical results of limited exposure and indirect reduction in treatment of tibial plateau fractures. Methods 41 cases of tibial plateau fractures were treated with limited exposure and indirect reduction. According to Schatzker classification, there were 6 cases of type Ⅰ, 13 type Ⅱ, 11 type Ⅲ, 6 type Ⅳ, 3 type Ⅴand 2 type Ⅵ. Type I fractures were reduced in the close manner by applying large reduction forceps and fixed with percutaneous lag screws. Type Ⅱ, type Ⅲand Type Ⅳfractures were reduced by applying large reduction forceps and fixed by percutaneous plating after restoring joint surface and bone grafting. Type Ⅴand Type Ⅵfractures were reduced by applying fracture distracter and large reduction forceps before they were fixed with percutaneous plating. The clinical outcomes were assessed according to Rasmussens system. Results 36 patients were followed up from 6 to 60 months, with an average of 30.2 months. No deep vein thrombosis, infection, or compartment syndrome was found postoperatively. All the 36 fractures united. Overall, 25 (69%) patients were rated as excellent, 8 (22%) good, and 3 (9%) fair. Conclusion In treatment of tibial plateau fracture, limited exposure and indirect reduction has advantages of less dissection, stable fixation, early movement, better joint function and fewer complications.