双侧锁定钢板结合植骨治疗复杂型胫骨平台骨折

Treatment of complex tibial plateau fractures with bilateral locking plate and bone graft

目的:探讨复杂型胫骨平台骨折手术治疗的有效方法和效果。方法:2008年5月至2011年4月收治复杂型胫骨平台骨折28例,男21例,女7例;年龄21～65岁,平均43岁。SchatzkerⅤ型11例,Ⅵ型17例。应用间接复位技术,双侧锁定钢板固定,结合自体髂骨植骨手术治疗。参照Rasmussen评价系统从临床和放射方面评定疗效。结果:28例获得随访,时间7～36个月,平均21.5个月。骨折愈合时间3～8个月,平均5.5个月。Rasmussen评价结果:临床评分:疼痛4.50±1.32,行走能力4.32±1.63,膝关节活动度4.07±1.34,膝关节稳定性4.78±1.27,伸膝关节4.85±1.12;放射评分:关节面塌陷5.07±0.92,平台增宽5.00±0.98,膝内外翻5.14±0.85;疗效结果:优8例,良15例,可3例,差2例。结论:复杂型胫骨平台骨折的治疗,充分评估并尽可能保护受损的软组织,选择合适的手术时机和手术切口,应用间接复位技术,有限切开及有效内固定,恢复关节面平整和良好下肢力线,早期功能锻炼,以达到最大程度恢复关节功能。

Objective ： To explore the effective methods for the treatment of complex tibial plateau fractures. Methods： From May 2008 to April 2011,28 patients with complex tibial plateau fractures were treated indirect reduction techniques, bi- lateral locking plate fixation combined with autologous bone grafts. There were 21 males and 7 females ,with an average age of 43 years ranging from 21 to 65. There were 11 cases in Schatzker type V, 17 in VI. The effect was evaluated by Rasmussen standard on clinical and radiological. Results：All patients were followed-up for 7 to 36 months （averaged of 21.5 months）. Healing time of fracture was from 3 to 8 months （averaged 5.5 months）. The results of Rasmussen scores in clinical was 4.50±1.32 in pain,4.32±1.63 in walking ability,4.07±1.34 in knee aetivity,4.78±1.27 in stability of the knee,4.85±1.12 in stretch knee; the results in radiation was 5.07±0.92 in articular surface collapse, 5.00±0.98 in platform widened, 5.14±0.85 in knee external varus. The effect result was excellent in 8 cases ,good in 15 ,fair in 3 and poor in 2. Conclusion： The key for the treatment of complex tihial plateau fractures was to fully assess the damage as much as possible to protect the soft tissue, select the appropriate timing of surgery and surgical incision, application of indirect reduction techniques, limited incision and effective internal fixation to restore joint surface smooth and good limb alignment, early exercise, in order to achieve maximum recovery of joint function.