胫骨平台骨折手术复位效果不佳的原因分析

Analysis of unsatisfactory open reduction of fractures of the tibial plateau

目的对胫骨平台骨折手术复位效果不佳的原因进行分析。方法对1995～1997年在我院治疗的胫骨平台骨折进行回顾 ,对其中35例关节面复位效果不佳的骨折 ,通过术后的X线片进行分析。结果总结出七种胫骨平台骨折手术复位效果不佳的原因 :(1)与胫骨棘相连的关节面同时出现旋转、塌陷 ,复位后关节面出现中心凹陷 ;(2)骨折块本身有压缩 ,但手术时未将压缩部分撬起 ;(3)植骨不实 ,且螺钉拧得过紧 ,造成关节面再次移位 ;(4)未清除胫骨平台骨折间夹有的碎骨块;(5)骨折整体复位垫起不足 ;(6)手术中摄X线片投照角度不佳 ,造成复位良好的假象 ;(7)骨折端过多的填塞植骨造成骨折分离移位。结论在胫骨平台骨折手术复位中 ,如能注意避免以上七种造成复位效果不佳的原因 ,将可能提高手术的复位水平。

Objective To analyze the reasons for unsatisfactory open reduction of tibial plateau fracture. Methods Thirty-five tibial plateau fractures treated operatively from l995 to l997 with unsatisfactory reduction of the articular surface had been reviewed.Results Seven potential reasons for unsatisfactory articular reduction were found:1)Failure to restore the rotational collapse of the articular surface connected with the tibial eminence that results in central collapse of the reduced articular surface. 2)The compression of the fracture fragment had not been completely lifted up during reduction,causing the incongruence of the articular surface. 3)Redisplacement of the reduced articular surface may occur due to loose bone graft and/or the over compression of the fixing screw. 4)The minor fragments between the condylar fracture line had not been cleared off. 5)The inadequate lifting of the fractured condyle. 6)Mimic image caused by inappropriate projection angle intraoperatively. 7)Separation of the fractured condyles due to over impaction of the bone graft between the fracture line. Conclusion Given the 7 potential reasons being considered, a more successful reduction of the tibial plateau fracture may be achieved.