胫骨平台骨折手术治疗64例体会

Operative Treatment of Tibial Plateau Fractures:Experience with 64 Cases

目的：探讨胫骨平台骨折内固定治疗的临床效果。方法：回顾性总结用单侧钢板、双侧钢板及单纯螺钉对不同类型的胫骨平台骨折作内固定的疗效。分析伤后手术时机和屈膝功能锻炼时间对膝关节功能恢复的影响。结果：本组共64例随访10~36个月,总优良率为92%。伤后第一阶段（1~5 d）手术,伤口一期愈合率为86%,伤后第二阶段（6~10d）手术,伤口一期愈合率为96%。术后2周内作屈膝功能锻炼者,膝关节伸屈功能90%以上恢复。结论：单侧钢板适用于Schectzker分类Ⅰ~Ⅳ型骨折,双侧钢板适用于Ⅴ~Ⅵ型骨折,单纯螺钉可用于Ⅰ~Ⅲ型骨折,但稳定性差。手术时机在受伤1周后局部水肿消退时为最佳。术中植骨可减少术后胫骨平台的下陷,并能早期屈膝及负重功能锻炼,促进骨折愈合及功能恢复。

Objective：To discuss the clinical effect of tibial plateau fractures with internal fixation.Methods：The treatment was retrospectively summarized using unilateral plate,double plate and simple screw to the different kinds of tibial plateau factures.The inffueaces of the operation time and the knee＇s functional exercise time on the recovery of knee joint function were analyzed.Results：Sixty-four cases were followed up,ranged from 10 months to 36 months,the excellent rate was 92 percent of the patients.To the first stage operation（from 1 to 5 days）after being injured,the wound healing by first intention was 86 percent,the second（from 6 to 10 days）,the rate of wound heding by first intention was 96 percent.More than 90 percent of the patients who had knee function exercises recovered from the knee joint flexcon and extending function two weeks after operation.Conclusion：Unilateral plate type Ⅰ～Ⅳ fracture accovduing Schectzker classification,double plate to typeⅤ～Ⅵfacture,and simple screw cowld be used in type Ⅰ～Ⅲ facture,but its stability was poor.The time of operation was exaptalec one week after being injured,when part of edema gduclly to subsided.The bone graft during the operation wonlel decrease the depussion of ftu tibial plateau after operation,and allow could function exercise in the early time,promoting the fracture acolcug and function recovery.