手术治疗陈旧性结构不稳性胫骨平台骨折的疗效分析

Effect of surgery for malunion of old fractures of tibial plateau with instability

目的:探讨陈旧性胫骨平台骨折及骨折后畸形愈合的手术治疗疗效。方法:2004年5月～2009年3月收治陈旧性胫骨平台骨折52例,从受伤或第一次手术至本次手术时间平均2.9个月(5周～12个月)。47例行截骨、软骨面抬高、植骨和内固定术;5例同时行自体骨软骨移植术。结果:平均随访64.2个月,骨折全部愈合;膝关节屈曲角度比健侧平均减少(13.2±2.8)°;按Merchant评分,优31例,良16例,可5例,优良率达90.4%。结论:应综合患者的年龄、病情考虑手术方案;术前常规X片、CT、MRI检查,关节面解剖复位,塌陷骨折复位后的植骨及坚强内固定以重建关节稳定性恢复下肢力线并早期功能锻炼是治疗成功的保证。

Objective： To explore the curative effect of surgery for malunion of tibial plateau fractures and old fractures of tibial plateau.Methods： Fifty-two patients（31 males,21 females） were reviewed and analyzed from May 2004 to March 2009 in our hospital.The average time from fracture or first operation to the treatment was 2.9 months（range,5 weeks to 12 months）.Forty-seven patients were treated with open osteotomy,reduction,bonegrafting and internal fixation.Five patients with full-thickness osteochondral defects were treated with open osteotomy,reduction,autologous mosaicplasty osteochondral transplantation and internal fixation.Results： The average follow-up time was 64.2 months.All fractures healed up.All knees demonstrated full extension,but the range of flexion decreased（13.2±2.8） ° in average compared to the opposite side.The Merchant score was excellent in 31 patients,good in 16 and fair in 5.Good rate was 90.4%.Conclusions： Successful therapy can be guaranteed by the following factors： routine X-ray,CT and MRI examinations before operation,anatomical reduction of articular surface,bone graft after reduction,forceful internal fixation and early functional exercises.