胫骨平台粉碎性骨折的手术治疗及疗效评价

Surgical treatment of tibial plateau fracture and treatment evaluation

目的：探讨胫骨平台骨折的手术治疗方法及影响术后疗效的相关因素。方法：筛选分析我院2010年9月～2012年10月期间收治住院的，年龄在18～60岁的胫骨平台粉碎性骨折患者中，按照Schatzker 分型标准，对于属于Ⅳ、Ⅴ、Ⅵ者作为入选本研究对象，其中Ⅳ型13例、Ⅴ10例、Ⅵ7例。各组病例均行标准X线正侧位片及CT扫描与三维重建，了解骨折块粉碎程度，与关节面塌陷情况，对疑有关节内结构损伤及侧副韧带损伤的病例加做MRI扫描。各组术中均彻底显露折端骨块及塌陷之关节面，并进行充分的复位，自体髂骨或异体骨填充骨缺损，钢板螺钉内固定，术后采用Rasmussen膝关节功能评价标准，分别于术后开始膝关节活动时（2周），1个月，3个月，6个月，1年5个时间段对对膝关节功能进行评估。结果：本组30例患者术后均获的随访，时间为1年，术后骨折均临床愈合，按Rasmussen膝关节功能评价标准评定，优8例，良16例，可5例，差1例，总优良率83％。所有病例均无神经血管损伤，深部感染，内固定松动或断裂等并发症发生。结论：对于胫骨平台粉碎性骨折，一切临床治疗方法的选择，均是围绕有效的膝关节功能回复，我们的研究认为，手术时机的选择，术中对于关节面及关节韧带的充分修复，关节整体结构力学的把握，同时配合有效的术后功能锻炼是胫骨平台粉碎性骨折获得良好临床效果的关键。

Objective：To explore the tibial plateau fractures methods and factors affecting the efficacy of postoperative .Methods：Screening in our hospital from September 2010 to October 2012 admitted to hospital during the ages of 18 to 60 years old patients with tibi-al plateau fractures , according to Schatzker classification criteria for belonging Ⅳ,ⅤandⅥwere selected as the study , of which 13 cases of typeⅣ, 10 cases of type Ⅴand 7 cases of type Ⅵ.The patients underwent standard X -ray radiographs and CT scans and 3D recon-struction, to understand the degree of comminuted fracture fragments and articular surface collapse case , the relevant section of suspected structural damage and the lateral collateral ligament injury cases plus an MRI scan .Each group of patients were completely exposed off -side and the collapse of the articular surface of the bone , and make full reset , autologous or allogeneic bone iliac bone defect filling , plate and screw fixation , postoperative knee function using Rasmussen evaluation criteria , respectively , in begins when knee surgery （ two weeks）, one month, three months, six months, one year time period five pairs of knee function evaluation .Results：The group of 30 cases of patients were followed up for 1 year after clinical healing fractures , according to Rasmussen knee function evaluation criteria were excell-lent in 8 cases, good in 16 cases, 5 cases and poor in 1 case, the total excellent rate of 83%.All patients had no neurovascular injury , deep infection , loosening or fracture fixation complications .Conclusion：For tibial plateau fractures , all clinical treatment options might be effective around knee function recovery , our study suggests that the choice of timing of surgery , intraoperative articular surface and for the full repair ligaments , joints overall structural mechanics grasp , in conjunction with effective postoperative functional exercise should be to get a good tibial plateau fracture critical clinical effect .