胫骨平台骨折的手术治疗及并发症防治探讨

Analysis of Surgical Treatment of Tibial Plateau Fracture and Prevention of Its Complications

目的对胫骨平台骨折治疗的临床结果进行分析，并对其相关并发症进行探讨，总结相关经验并提出有效预防措施．方法回顾性分析胫骨平台骨折手术患者74例，骨折类型按Schatzker分型，其中Ⅰ型10例。Ⅱ型15例，Ⅲ型11例，Ⅳ型10例，Ⅴ型12例，Ⅵ型16例．Ⅰ型骨折采用切开复位松质骨拉力螺钉固定，其他类型采用切开复位、钢板螺钉内固定，缺损塌陷处自体或同种异体骨植骨．并对术后并发症进行分析．结果74例获得随访，随访时间1—5a，平均3．2a，功能评价采用Hold膝关节功能分级系统，临床结果优良率达90％，术后各种并发症18例，其中创伤性关节炎10例，关节强直2例，关节不稳4例，感染2例。结论手术内固定是治疗胫骨平台骨折的重要方法，术中解剖复位、牢固内固定、术前正确处理并发症及早期正确适当功能锻炼能有效预防术后并发症，提高手术效果．

Objective To explore surgical treatment of tibial plateau fractures and investigate effective operative procedures. To analyze complications after operation and put forward effective preventional measures. Method Seventy - four cases of tibial plateau fractures were treated with internal fixation from Jan. 2001 to Dec. 2005 in the hospital. According to Schatzker classification, type Ⅰ 10cases, type Ⅱ 15 cases, typeⅢ 11 cases, type Ⅳ 10 cases, type Ⅴ 12 cases and type Ⅵ 16 cases. Type Ⅰ were all treated with annulated screws, other types were treated with open reduction and internal fixation with buttress plates and autologous or other persons＇ bone grafts. Complications were analyzed carefully. Results All patients were followed up for 1 - 5 years （averaged 3.2 years）. The clinical results were assessed according to Hoh1 scale for knee joint. The excellent and good results were 90%. Eighteen cases had complications including traumatic arthritis 10 cases, articular stiffness 2 cases , articular instability 4 cases and formation of fistula 2 cases. Conclusions Internal fixation is effective methods of treating tibial plateau fracture. That complete reduction, suitable internal fixation, well - management of these complications before surgery, and proper exercise post operation are effective measures of preventing complications.