胫骨平台骨折临床治疗经验探讨

Exploration of Clinical Experience in Treating Fracture of Tibial Plateau

【目的】总结胫骨平台骨折的临床治疗经验。【方法】回顾总结分析98例胫骨平台骨折患者的临床资料。I型无明显移位骨折11例均给予保守治疗,采用包括手法复位、夹板固定、皮牵引、功能锻炼、中药内服(分3期治疗:早期用桃红四物汤加减,中期用接骨续筋汤加减,后期用壮骨丸加减)和中药外洗(采用舒筋活血外洗方)等中医综合疗法;I型明显移位骨折及Ⅱ～Ⅵ型骨折共87例均给予手术治疗。【结果】98例骨折中,按Schatzker分型:I型25例,Ⅱ型22例,Ⅲ型13例,Ⅳ型18例,V型11例,Ⅵ型9例。98例患者均获得随访,随访期6～36个月,平均19个月,膝关节功能评价参照HSS评分标准,优39例,良47例,差12例,优良率为87.8%。【结论】胫骨平台骨折对位对线良好,可保守治疗;对关节面塌陷移位的胫骨平台骨折宜采用切开复位内固定,根据骨折分型及骨折移位情况采取不同治疗手段,骨折准确复位、恢复关节面平整、正确选择手术入路及内固定物、注重软组织的保护及修复是保证手术治疗取得良好效果的重要因素,配合中医中药和功能康复训练治疗是膝关节功能康复的必要手段。

Objective To summarize the clinical experience in treating fracture of tibial plateau.Methods A retrospective analysis of the clinical data was carried out in 98 patients with fracture of tibial plateau which were admitted from January,2004 to September,2010.Eleven patients with type I fracture of tibial plateau but without obvious dislocation were given conservative treatment.The conservative treatment included manipulative reduction,splint fixation,skin traction,functional exercise,oral use of herbal medicine,and external application of tendon-soothing and blood-activating herbal medicine for washing.The oral use of herbal medicine was based on three-stage differentiation of fracture,i.e.,modified Tao Hong Siwu Decoction for the early stage,modified Jiegu Xujin Decoction for the middle stage,and modified Zhuanggu Pill for the late stage.The patients with type I fracture of tibial plateau and obvious dislocation,and the patients with type Ⅱ～Ⅵ fracture of tibial plateau were 87 cases in total,and they were given operation.Results According to Schatzker＇s classification for fracture of tibial plateau,of 98 cases,25 were type I,22 were typeⅡ,13 were type Ⅲ,18 were type Ⅳ,11 were type V,and 9 were type Ⅵ.All of the patients were followed up.The follow-up period covered 6～36 months,and averaged 19 months.The results of knee function scoring with the Hospital for Special Surgery Scale（HSS） showed that 39 had excellent score,47 had good score,12 had poor score,and the excellent and good rate was 87.8%.Conclusion Conservative treatment is suitable for tibial plateau fracture with good apposition and alignment.Open reduction and internal fixation are suitable for tibial plateau fracture with dislocation and collapse of articular surface.It is indicated that restoration of articular surface,protection of soft tissues,excellent reduction,correct route of incision,and correct internal fixation are the key for the success of the operation for fracture of tibial plateau.The combination of oral use and external application of herbal medicine as well as functional rehabilitation and exercise is helpful for the recovery of knee function.