Schatzker Ⅳ～Ⅵ型胫骨平台骨折的治疗策略及预后影响因素

Management and influencing factors of surgical treatment for Schatzker type Ⅳ ~Ⅵ tibial plateau fractures

目的：探讨SchatzkerⅣ～Ⅵ型胫骨平台骨折治疗策略及影响预后的因素。方法对167例SchatzkerⅣ～Ⅵ型胫骨平台骨折患者分别采用双钢板及锁定板加空心螺钉治疗，分析术后疗效及相关的影响因素。结果167例均获得随访，时间13～57个月。采用Rasmussen膝关节功能评分标准评价疗效：优95例，良43例，可22例，差7例，优良率为82．6％。结论术前准确评估骨折类型及移位程度，注重软组织损伤程度的评估，选择合适的手术时机、入路和固定方法，关节面的解剖复位、充分植骨、可靠的固定，术后正确指导功能锻炼、积极预防各种并发症，是提高SchatzkerⅣ～Ⅵ型胫骨平台骨折临床治疗效果的关键。

Objective To explore management and influencing factors of surgical treatment for Schatzker type Ⅳ~Ⅵtibial plateau fractures.Methods 167 cases of Schatzker type Ⅳ~Ⅵtibial plateau fractures treated with dual plat-ing or locking plates plus cannulated screws internal fixation were analyzed retrospectively.Postoperative effects and possible influential factors were observed.Results 167 patients had been followed up for 13~57 months.According to Rasmussen joint functional grading system,excellent in 95 cases,good in 43,fair in 22,and poor in 7,the excellent and good rate was 82.6%.Conclusions In order to obtain excellent clinical results of complex fracture of tibial plat-eau,the key points consists of accurately evaluating fractures and soft tissue injuries,choosing operational opportunity before operation,conducting anatomical reduction as far as possible and forceful fixation during operation,directing the patients joint functional exercise and preventing various complications after operation.