145例胫骨平台骨折手术治疗分析

Shinbone platform fracture operation treatment:an analysis for 145 cases

目的总结胫骨平台骨折的临床特征,治疗方法及疗效。方法根据schatzker分类法,将145例胫骨平台骨折分型。Ⅰ型、Ⅱ型、Ⅲ型及部分Ⅳ型应用"高尔夫"钢板内固定,部分Ⅳ型、Ⅴ型及Ⅵ骨折,应用高尔夫钢板及加用"T"型钢板内固定。Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ型取自体髂骨植骨。结果本组141例获得随访,随访时间10～51个月,平均随访36.3个月。全部骨析均临床愈合,无植骨坏死,内固定松动断裂等发生。优79例,良53例,可5例,差4例,优良率为93.5%。结论胫骨平台骨折需根据骨折类型选择合适的手术治疗方案。满意的疗效取决于:①关节面的平整,下肢力线的恢复;②骨折压缩,塌陷骨折复位后,骨质缺损部需植骨;③妥善处理软组织,包括前交叉韧带、半月板、侧副韧带的损伤;④同时注意腓总神经的挫伤、压迫的解除。

Objective To summarize the clinical feature,treatment and effect on the shinbone platform fracture.Methods According to the schatzker classification,145 cases shinbone platform bone fracture were enrolled.Ⅰ,Ⅱ,Ⅲ and someⅣ types were fixed with＂GOLF＂armor plate,while some Ⅳ,Ⅴand Ⅵ types were fixed with＂GOLF＂and＂T＂armor plate.Grafts were from autologous ilium for Ⅱ,Ⅲ,Ⅳ,Ⅴ,Ⅵ types.Results 141 cases were followed up by 10～51 months,average for 36.3 months.All cases were healed without osteonecrosis,fixed armor plate mobility and rupture.The healing effect was divided into four grades：excelent 79 cases,well 53 cases,passable 5 cases,bad 4 cases.The favorable rate was 93.5%.Conclusion Appropriate operation methods should be done on the base of shinbone platform types.The satisfaction effect is depend on such factors as：1 neat articular surface and recovery of lower limbs;2 disrepais need bone grafting;3 treat parenchyma carefully,including front-cross ligament,meniscus,side vice ligament;4 take care the remove of sprain and oppression on the fibula nerve.