影响胫骨平台骨折手术疗效的相关因素分析及其对策

Analysis on Prognostic Relative Factors of Influencing Therapeutic Efficacy in Operative Treatment of Tibia Plateau Fractures and Strategies

【目的】分析胫骨平台骨折的手术疗效，探讨影响手术疗效的相关因素及其有效的防治措施。【方法】对2002年3月至2007年4月在本院行手术治疗的76例胫骨平台骨折患者的临床资料进行回顾性分析，骨折类型按Schatzker分型，临床疗效依据Rasmussen膝关节功能评分标准，分析影响手术疗效的相关因素并提出相应的防治措施。【结果】76例患者均获得随访，平均随访时间27.2（9～67）个月，根据Rasmussen评分；优43例，良23例，可6例，差4例，优良率86、84％，术后发生明显并发症11例，其中关节僵硬1例；创伤性关节炎6例，其中包含关节面重新出现塌陷3例;伤口并发症4例。【结论】影响胫骨平台骨折手术疗效的主要因素有骨折类型、关节面复位质量、术后胫骨平台高度的丢失情况等。只有通过提高关节面复位质量、坚强内固定和充分确实的植骨以防止胫骨平台高度丢失、术中尽可能保护和修复附属软组织结构以及术后正确的关节功能康复治疗可获得满意的疗效。

[Objective] To analyze the result of operative treatment of tibial plateau fracture and to explore its relative factors of influencing the therapeutic effect and effective prevention measures. [Methods] Clinical data of 76 patients who suffered tibial plateau fracture and received operative treatment from March 2002 to April 2007 in our hospital were retrospectively analyzed. Classification of tibial plateau fractures was done according to Schatzker classification system. Clinical results after operation were evaluated by the Rasmussen＇s criteria. The relative factors of influencing the surgical effect were analyzed and the corresponding prevention measures were provided. [Results] All the cases were followed up from 9 to 67 months（27.2 months on average）. The clinical results were assessed according to Rasmusseffs criterion for knee joint as excellent in 43 patients, good in 23, fair in 6 and poor in 4. The excellent and good rate was 86. 84%. There were 11 cases occurred with obvious complications including articular stiffness in 1 patient, traumatic arthritis in 6 cases of which 3 cases occurred tibia plateau articular depression, wound complications in 4 patients. [Conclusion]Discouraged results of tibia plateau fracture are significantly related to fracture type, quality of reduction and postoperative reduction loss of tibial plateau, hnproving quality of reduction, rigid internal fixation and sufficient bonegraft to avoid postoperative reduction loss, a good protection and recovery of the soft tissue of the knee joint structure and correct and effective function rehabilitation are significant measures to ensure excellent clinical results in treatment of tibia plateau fracture.