胫骨平台骨折手术复位效果不佳的原因分析

目的对胫骨平台骨折手术复位效果不佳的原因进行分析。方法对2006年1月至2008年1月在本院治疗的胫骨平台骨折病例进行回顾总结，对其中35例关节面复位效果不佳的骨折病例，通过术后的X线片进行分析。结果总结出7种胫骨平台骨折手术复位效果不佳的原因：（1）中间关节面同时出现旋转塌陷，复位后关节面抬高不够，出现中心凹陷，或抬高过高超过层面；（2）骨折块本身有压缩或下沉，手术时未将压缩部分完全提高，或者骨折端过多的填塞植骨造成骨折分离部分移位或者复位不佳；（3）术前准备不充分；（4）未清除胫骨平台骨折间嵌夹的碎骨块；（5）额状面骨折时由于后侧骨块固定困难引起胫骨后侧平台复位不佳；（6）手术中C形臂X线机球管投照角度不佳，造成复位良好的假象；（7）手术中过分追求外观而忽视关节面的平整。结论在胫骨平台骨折复位中，如能注意避免以上7种造成复位效果不佳的原因，将可能提高手术的复位水平。

Objective To analyze the causes for unsatisfactory open reduction of tibial plateau fracture. Methods Thirty - five tibial plateau fractures treated operatively from 1995 to 1997 with unsatisfactory reduction of the articular surface bad been reviewed. Results Seven possible causes for unsatisfactory articular reduction were found： （ 1 ） Failure to restore the rotational collapse of the articular surface connected with the tibial eminence that results in central collapse of the reduced articular surface. （2） The compression of the fracture fragment had not been completely lifted up during reduction, causing the incongruenee of the articular surface. （ 3 ） Redisplacement of the reduced articular surface may occur due to loose bone graft and / or the over - compression of the fixing screw. （ 4 ） The minor fragments between the condylar fracture line bad not been cleared off. （ 5 ） The inadequate lifting of the fractured condyle. （6） Mimic image caused by inappropriate projection angle intraoperatively. （7） Separation of the fractured condyles due to over - impaction of the bone graft between the fracture line. Conclusion Given the 7 possible causes being considered, a more successful reduction of the tibia1 plateau fracture may be achieved.