内侧胫骨平台骨折手术治疗(附27例分析)

Operative Treatment of Medial Fracture of Tibial Plateau(27 Case Report)

目的探讨Sehatzker Ⅳ型胫骨平台骨折的损伤特点、疗效差的原因和改进的方法。方法 根据Schatzker Ⅳ型胫骨平台骨折的损伤特点，将诊治的27例患者分为劈裂型、整髁型和塌陷型。对劈裂型和整髁型骨折，无关节面塌陷者，采用内侧切口；CT检查示有关节面塌陷者，采用正中切口纠正塌陷并植骨；劈裂型支撑钢板在内后侧固定，整髁型支撑钢板在内侧固定或双侧支撑钢板固定。对塌陷型骨折，采用内侧切口，行复位、植骨、支撑钢板内侧固定。20例患者术后平均随访41个月，对影响骨折预后的因素进行分析。结果随诊的20例患者膝关节活动度为30°-140°（平均110°）；Lysholm评分平均为83.2分，优8例、良5例、中5例、差2例。结论应根据分型和CT检查结果选择手术入路和固定方法；膝内翻畸形、平台增宽或向外移位是影响预后的因素。

Objective To study the characteristic,treatment and prognosis of tibial plateau fracture Schatzker type Ⅳ. Methods According to the roentgenogram and CT scan in 27 patients, Schatzker type I injury is divided into 3 types： spht,total condoler,depression. In the treatment of split and total condylar injury, if there was no articular depession on CT scan, reduction is done through medial approach; if CT scan demonstrated articular depression, middle approach was used to reduce the depression and bone graft. In split injury, buttress plate was fix on posterior - medial side. In total condylar injury,buttress plate is fix on medial side. In depression injury, fracture was reduced through medial approach, bone graft and buttress plate was fix on medial side. Twenty patients were followed up in 41months averagely. And the statistical analysis was done. Results The average Lysholm score of 20 patients was 82.2. Eighe patients were excellent, 5 were good,5 were fair, 2 were poor. The range of molion from 30 to 147 （average 110）. Conclusion In order to get anatomical reduction and stable foxaion, the approach and fox pattern should be chosen on the bases of classification and CT scan of Schalzker Ⅳ injury.