植骨加钢板内固定治疗胫骨平台骨折56例

Treatment of Tibial Plateau Fractures by General Bone Grafts and Support Plate Internal Fixations

目的探讨常规植骨加支撑钢板治疗胫骨平台塌陷骨折的临床效果。方法回顾2000年1月一2004年12月收治的胫骨平台骨折72例,按Schatzker分型II型14例,III型19例,IV型9例,V型10例,VI型4例。男48例,女24例,年龄在19一61岁,平均42岁,闭合性损伤68例,开放性损伤4例。72例均根据骨折情况灵活选取切口行切开复位支撑钢板内固定。关节面塌陷56例行自体骨或同种异体骨植骨支撑,术后早期应用CPM机活动膝关节。结果56例全部获得随访,随访8一60个月,平均33个月。56例全部获得骨折愈合,膝关节功能按Merchant标准综合分析,优32例,良16例,可6例,差2例,优良率为85.71%。结论灵活选取切口应用常规植骨加支撑钢板内固定治疗胫骨平台骨折,固定牢靠,可早期功能锻炼,关节功能恢复好,并发症少,后期无一例塌陷畸形。

Objective： To investigate the clinical results of general bone grafts and support plate internal fixations in the treat-ment of tibial plateau fractures. Methods：72 cases （48 male and 24 female,aged from 19 to 61 years old with an average of 42 ） of fractures of the tibial plateau were treated by the support plate internal fixations and the bone grafts from Jan. 2000 to Dec. 2004. According to Schatzker classification, there were 14 type Ⅱ , 19 type Ⅲ ,9 type Ⅳ ,10 type V and 4 type Ⅵ. There were 68 close fractures and 4 open fractures among 72 cases. All patient flexibly selected incision by fracture condition and underwent open reduction and support plate internal fixation. In addition, self or homogeneous variant bone grafting were used in articular surface subside cases, and CPM was used in early stage to keep the knee joint active. Result： 56 patients were followed up from 8 to 60 months, with an average of 33 months. All the 56 fractures united. According to the standards of Merchant, the curative effect was excellent in 32 patients, good in 16 , fair in 6 and bad in 2, 85.71% of the cases were rated as excellent or good. Conclusion：In the treatment of tibial plateau fractures, flexible selection of incisions, general bone grafts and support plate internal fixations have the advantages of stable fixation, early movement, better joint function, fewer complications and no terminal subside abnormality.