胫骨平台骨折手术治疗效果的析因分析

Analyzes Efficacy of Treatment Techniques on the Reduction of Tibial Plateau Fracture

目的：回顾性分析不同手术方式治疗不同类型胫骨平台骨折的疗效,并对各种影响因素进行分析.方法：选取我院2002年1月～2010年12月胫骨平台骨折行手术治疗患者94例,男性72例,女性22例,平均年龄52岁,空心螺钉治疗55例,单纯钢板治疗21例,钢板加植骨术18例,根据治疗方式及骨折严重程度将所有患者分为4组及2个亚组,对照组为空心螺钉固定组,临床随访平均50.4个月,对患者随访过程的SF36,WOMAC,Rasmussen分值进行评估.结果：与对照组相比,单纯钢板治疗组临床效果较好（OR=5.613; p=0.004 ）,在Schatzker IV,V,VI型骨折中,钢板加植骨术治疗组临床效果较好（OR=13.832; p=0.008）.单纯钢板治疗组SF36评分最低,植骨术可以改善钢板治疗胫骨平台骨折的临床疗效.结论：在相同程度的骨折情况下,运用钢板加植骨术更有利于恢复膝关节功能.

Objective： This retrospective study analyzes efficacy of treatment techniques on the reduction of tibial plateau fracture. Methods： 94 patients from January 2002 to December 2010 who suffer from tibial plateau fracture were evaluated, 72 males and 22 females. The average age is 52. 55 patients were treated with cannulated screw alone, 21 were treated with plates alone, and 18 were treated with both plates and bone substitutes. All patients were clinically and radiographically followed up for an average time of 50.4 months. SF36, WOMAC and Rasmussen score were analyzed. According to the operating method and the severity of the fracture, patients were divided into 4 groups and 2 subgroups. The patients who were treated with screws alone considered as control group. Results： Compared with the control group, the use of plates alone obtained a clinically more effective result （OR=5.613; p=0.004 ）, even more when comparing Schatzker type IV, V, VI （OR=13.832; p=0.008）. Patients treated with plate alone have rewarded the lowest score with regard to the SF36. The use of bone substitutes could improve the treatment of the most severe tibial plateau fractures. Conclusion： The treatment of tibial plateau fractures with plates can be improved with the use of bone substitutes, expecially with the goal of achieving a complete functional recovery of the knee.