老年胫骨平台骨折内固定失效原因与对策

Causes and strategies of internal fixation failure in senile fracture of tibial plateau after operation

[目的]通过对老年胫骨平台骨折手术治疗失效的病例分析,探讨失效原因及防范对策。[方法]对1990年1月～2006年10月间经治的60例病人中的19例内固定失效病例,做回顾性总结分析。[结果]60例均获随访,随访时间最短18个月,最长48个月,平均随访32个月。膝关节功能按雍氏评级标准。有19例发生内固定失效,占31.7%。判定标准:关节面塌陷>3 mm和/或轴向对线不良>5°,关节脱位,螺钉钢板松动,螺钉穿出关节面。[结论]术前未对老年患者伤情进行正确诊断评估,未能正确判断骨折类型,手术适应证的掌握及内固定方式选择失当,手术操作中植骨术欠规范,复位固定未达到解剖要求等是造成内固定失效的主要原因。

[ Objective ] To investigate the causes and strategies of internal fixation failure in senile fracture of tibial plateau after operation. [ Method] Data from internal fixation failure patients out of 60 patients undergoing surgical treatment from Jan. 1990 to Oct. 2006 were retrospectively studied. [ Result] All of the sixty patients were followed up for an average of 32 months, （ranged,18 -48 months）. The knee joint function was ranked according to the Yong＇ s standard. Nineteen patients （31.7%） was classified as having internal fixation failure. The internal fixation failure included articular facet collapse 〉 3ram and/or axial direction malalignment 〉 5° , dislocation of joint, instability of screws and plates and penetration of the screws into the joint surface. [ Conclusion ] Incorrect preoperative evaluation of the injury severity, incorrect judgement of the fracture type, improper operation indications, improper selection of internal fixation methods, nonstandard technique of bone graft and failure to reach anatomic reduction are the main causes of internal fixation failure.