胫骨平台骨折内固定方法的选择

Selection of Internal Fixation Methods for Tibial Plateau Fractures

目的:探讨胫骨平台骨折内固定方法,提高胫骨平台骨折的治愈率,降低伤残率。方法:通过对2003年10月-2007年10月间手术的176例胫骨平台骨折(其中属于陈旧的33例)的治疗进行回顾性分析。全部切开复位,选择不同的内固定方法加植骨。采用Golf钢板及松质骨拉力螺钉以及双钢板内固定术。结果:术后随访6个月～4年,平均16个月,骨折端达到解剖复位,骨折端愈合良好,膝关节屈曲功能恢复至90～120°,参照lysholm评分标准,根据骨折复位情况、愈合情况、功能恢复情况及有无并发症等条件评分,优145例,良18例,可13例,,优良率为92.6%。结论:治疗胫骨平台骨折,依据其分型选择合适的内固定方法,严格达到关节面的解剖复位,坚强的内固定和塌陷骨折的复位加植骨,术后早期3周不负重功能锻炼可以明显的改善胫骨平台骨折的治疗效果,恢复关节的功能,减少并发症的发生。

Objective：To investigate the effective methods of internal fixation for tibial plateau fractures, so to increase the cure rate and decrease the disabilities rate. Methods： Retrospective 176 cases of tibial plateau fractures treated by open reduction and internal fixation （old 33 cases） with different fixation methods （Golf plate, screws of cancellous bone, double plates） and bone autograft from October 2003 to October 2007. Results： All the cases were followed for 6 to 48 months （mean 16 months） postoperative. They were all got anatomy reduction of articulation surface, and the mean flexion achieved 90-120°. According to Lysholm evaluation system, 145 cases were excellent （82.38%）, 18 cases were good （10. 22%）, and 13 cases were fair （7.38%）, and the good rate was 92.6%. Conclusion：The suitable internal fixation method for tibial plateau fractures depending on the type of the fractures. The effective and little complication need the anatomical reduction of articular surface, strongly internal fixation, auto graft of cancellous bone, and three weeks exercise without weight-bearing.