分期治疗合并骨筋膜室综合征的胫骨平台骨折

Stage therapy for the treatment of fractures of tibia plateau with osteofascial compartment syndrome

目的:根据胫骨平台骨折并发骨筋膜室综合征的临床特点,探讨其分期治疗的手术方法及临床疗效。方法:2014年4月至2017年5月,采用分期治疗方法治疗合并骨筋膜室综合征的胫骨平台骨折患者22例,男16例,女6例;年龄22～56岁,平均39岁;左侧15例,右侧7例;开放性骨折2例,闭合性骨折20例。所有患者严密进行临床病情观察,根据其特点,依次分为骨筋膜室综合征窗口期(窗口期)、切开减压期(减压期)、软组织评估期(评估期)及骨折终末固定恢复期(恢复期)。所有患者切开减压。结果:骨折均愈合,愈合时间3～9个月,平均6个月。按照Merchant膝关节功能评分标准评定疗效,优18例,良3例,可1例。结论:分期治疗能够早期发现、早期诊断及早期治疗筋膜间室综合征,并且能够全程观察患肢软组织情况,避免了骨筋膜室综合征的误诊、漏诊及误治、失治,是一种便捷、有效、值得推广的方法。

Objective:To study the operative methods and clinical effects of stage therapy for the treatment of fractures of tibia plateau with osteofascial compartment syndrome according to its clinical characteristics. Methods:From April 2014 to May 2017,22 patients with fractures of tibia plateau with osteofascial compartment syndrome were treated by stage therapy,including 16 males and 6 females,ranging in age from 22 to 56 years old,with an average of 39 years old. Fifteen patients had injuries on the left and 7 patients had injuries on the right. Open fracture occurred in 2 cases,and closed fracture occurred in 20 cases. According to its characteristics,all the patients were divided into the window period(window period),the open decompression period(decompression period),the evaluation period of soft tissue(evaluation period) and the fixed recovery period of fracture terminal(recovery period). All the patients were treated with incision and decompression. Results:All fractures healed. The healing time ranged from 3 to 9 months,with an average of 6 months. According to the Merchant knee function score to evaluate the curative effects:18 cases got an excellent result,3 cases good and 1 case fair. Conclusion:Stage therapy is effective to find early,diagnose early and treat early for fascia compartment syndrome,as well as to observe the soft tissue of the affected limb all the way,so as to avoid misdiagnosis,missed diagnosis,mistaken treatment and out of treatment of fascia compartment syndrome. It is a convenient,effective and worthy of promotion method.