复杂胫骨平台骨折手术治疗分析

Surgical Treatment for Complex Tibial Plateau Fractures

目的总结复杂胫骨平台骨折手术治疗的临床经验。方法 2007年1月2009年12月,采用切开复位内固定治疗复杂胫骨平台骨折56例。男37例,女19例;年龄19～76岁,平均45.6岁。骨折按Schatzker分型:Ⅳ型12例,Ⅴ型26例,Ⅵ型18例。合并半月板损伤20例,膝内侧副韧带损伤9例,外侧副韧带损伤8例,交叉韧带损伤4例。受伤至手术时间7～14d,平均9d。结果术后53例切口Ⅰ期愈合;2例术后3d切口出现浅表感染,1例术后7d外侧切口出现皮肤坏死、钢板外露,均对症处理后愈合。56例均获随访,随访时间14～49个月,平均19个月。骨折均于术后4～8周愈合,平均6周。并发膝关节僵硬1例、创伤性关节炎2例、异位骨化1例,相应处理后治愈。术后12个月按美国特种外科医院评分标准评价疗效,获优43例,良5例,可4例,差4例,优良率85.7%。结论手术治疗复杂胫骨平台骨折需重视软组织条件,掌握好手术时机、选择合适内固定、提高手术技巧、术后有效的功能锻炼是保证疗效的关键。

Objective To summarize the clinical experiences of surgical treatment for complex tibial plateau fractures. Methods From January 2007 to December 2009, 56 patients with complex tibiaI plateau fractures underwent open reduction and internal fixation. The patients included 37 males and 19 females with the age of 19 76 years old （average 45.6 years old）. The Schatzker type of the fractures were type IV in 12 patients, type V in 26, and type VI in 18. The injuries included meniscus injury in 20 patients, injury of lateral collateral ligament of knee in 9, injury of lateral collateral ligament in 8, and cruciate ligaments injury in 4. The time duration between the injury and the surgery was 7 14 days （average 9 days）. Results After the surgery, the incision healed at I stage in 53 patients. The incision was superficially infected 3 days after surgery in 2 patients, and the Necrosis of skin around the incision and revealed steel plate were found 7 days after surgery in 1 patient; the injuries treatment. All of the patients were followed up with the average follow-up period was healed after corresponding of 14-49 months （average 19 months）. The fractures healed 4-8 weeks （average 6 weeks） after the surgery. Knee joint ankylosis was found in one, traumatic arthritis was found in two, and heterotopic ossification was found in one; the injuries was healed after corresponding treatment. Twelve months after the surgery, the therapeutic effect according to HSS criteria indicated that the score was excellent in 43, good in 5, generally in 4 and poor in 4; with a fine rate of 85. 7%. Conclusion Appropriate conditions of the soft tissue, good surgical opportunity, a appropriate fixation, improved surgical technique and effective postoperative functional training are the key points of surgical treatment for complex tibial plateau fractures.