复杂胫骨平台骨折的手术治疗

Surgical treatment of the complicated fractures of the tibial plateau.

目的探讨复杂性胫骨平台骨折的手术治疗方法和疗效，为临床选择更好的治疗复杂性胫骨平台骨折的方法。方法自1997—2006年收治胫骨平台骨折76例，按照Schatzker分型复杂胫骨平台骨折37例，男性31例，女性6例。均经切开复位，严格按照内固定原则分别采用螺丝钉、钢板或外固定架固定进行骨折治疗。结果37例均得到随访，最短19个月，最长7年，平均23个月。骨折均愈合，疗效评定参照Merchant标准，术后6个月优良率为83、8％，术后1年优良率为89.2％。结论复杂性胫骨平台骨折应当考虑手术治疗，术中必须早期处理受损的软组织；内固定物的选择应当灵活掌握。

Objective To investigate the therapeutic methods and effect for the complicated fracture of tibial plateau and to determine which therapeutic method is better. Methods 76 patients with fractures of tibial plateau were treated in our hospital from 1997 to 2006. According to Schatzkerg classification, 37 patients （male 31 ,female 6 ） suffered from complicated fractures of tibial plateau, of which 19 patients belonged to type Ⅳ, 5 patients type Ⅴ, and 13 patients type Ⅵ. Patients were treated with screw internal fixation, steel plate internal fixation or external fixation respectively. Results The average length of followed - up were 23 months （ range, 19 months to 7 years）. Fractures healed in all the 37 patients. Based on Merchant criteria, the recovery of knee joint function were excellent in 83.8% of the patients 6 months after operation and in 89. 2% of the patients 1 year after operation. Conclusion It is highly recommended that open reduction and internal fixation are performed in the treatment of complicated fractures of tibial plateau. Early treatment of soft tissue injury is necessary. Internal fixators should be chosen according to particular conditions of the patients.