复杂型胫骨平台骨折的手术治疗

Operative treatment for complex tibial plateau fractures

目的:探讨高能量损伤所致复杂型胫骨平台骨折的手术治疗方法及临床效果。方法:2006年3月至2009年5月对48例复杂型胫骨平台骨折采用切开复位钢板内固定治疗,男37例,女11例;年龄18～63岁,平均37岁。根据Schatzker分型:Ⅳ型16例,Ⅴ型20例,Ⅵ型12例。所有患者术前行正侧位X线片及CT三维重建检查。术后随访X线片,并进行膝关节Merchant评分评估疗效。结果:48例术后均获随访,平均随访时间14个月。骨折18周内全部愈合。根据Merchant评分标准进行膝关节功能评价:优24例,良16例,可6例,差2例。结论:掌握合适的手术时机,争取最佳解剖复位,选择合适的内固定,必要时植骨,配合术后及时合理的康复锻炼,能使复杂型胫骨平台骨折的膝关节功能得到最大恢复。

Objective：To explore the surgical methods and clinical evaluation of complex tibial plateau fractures resulted from high-energy injuries. Methods：From March 2006 to May 2009,48 cases with complex tibial plateau fractures were treated with open reduction and plate fixation,including 37 males and 11 females,with an average age of 37 years（ranged from 18 to 63 years）. According to Schatzker classification,16 cases were type Ⅳ,20 cases type V and 12 cases typeⅥ. All patients were examined by X-ray flim and CT scan. The function of knee joint were evaluated according to postoperative follow-up X-ray and Knee Merchant Rating. Results：Forty-eight patients were followed up with a mean time of 14 months. According to Knee Merchant Rating,24 cases got excellent results,16 cases good,6 cases fair and 2 cases poor. Conclusion：Appropriate operation time,anatomical reduction,suitable bone graft and reasonable rehabilitation exercises can maximally recovery the function of knee joint.