内固定治疗胫骨平台骨折的疗效分析

Analysis of clinical effect on the tibial plateau fractures by internal fixation

目的探讨胫骨平台骨折内固定的方法,评估内固定手术的疗效。方法回顾性分析本组收治的胫骨平台骨折患者74例。均为外伤后2周内的新鲜骨折,男58例,女16例,年龄16～72岁,平均46.3岁。合并膝关节韧带及半月板损伤共30例。骨折按Schatzker分类,Ⅰ型9例,Ⅱ型42例,Ⅲ型8例,Ⅳ型5例,Ⅴ型3例,Ⅵ型7例,根据骨折的类型采用不同的切口进行切开复位内固定治疗,骨缺损者同时予以植骨。结果72例患者均获得随访,随访期3～42个月,平均34个月,全部骨性愈合。术后膝关节功能评价参照HSS评分标准:优51例,良12例,中9例,优良率为87.5%。结论内固定是治疗胫骨平台骨折的有效方法,手术方法根据骨折的不同类型而异,术后并发症的发生与骨折损伤程度、手术时机的选择和手术复位的质量密切相关。应尽量争取早期解剖复位、骨缺损植骨、稳定固定和早期非负重功能锻炼。术前必须重视软组织损伤的评估。

Objective To investigate the fixation methods of tibial plateau fracture and assess their efficacy. Methods Seventy-four cases of tibial plateau fractures treated from January 2003 to December 2008 in our hospital were retrospectively analyzed. All cases were fresh fractures which were treated within two weeks after the trauma. Among them, 58 cases were male, 16 cases were female. The patient was aged 16 -72 years old （average 46.3 years old）. 30 cases complicated with ligament and the meniscus injury in knee. According to Sehatzker＇s classification, 9 cases were type I , 42 cases were type Ⅱ , 8 cases were type m, 5 were type IV, 3 were type V and 7 cases were type VI. According to the type of fracture, different incision was used for the treatment of open reduction and internal fixation, allograft bone was planted at the same time if the bone damage existed. Results Seventy-two cases were followed up from 3 - 42 months, with an average of 34 months. All the fractures healed. According to the HSS criteria, the function of the knee joint was rated as excellent in 51 patients, good in 12 and fair in 9. The satisfactory rate was 87. 5%. Conclusions Intenal fixation is an effective method to treat tibial plateau fracture, and the operation procedures should be varied with the fracture types. Complications after operation are closely associated with the degree of damage, the timing of surgery and the quality of surgical reduction. Early anatomical reduction, bone transplantation, stable intenal fixation, and early non-weight-bearing functional exercises are important. Soft tissue injury must be evaluated accurately.