胫骨平台骨折疗效不佳原因与对策

The Cause and Treatment of the Poor Prognostic of Tibia Plateau Fracture

目的 评价胫骨平台骨折的治疗效果 ,分析疗效不佳的原因并提出对策。方法 收集 1992年 10月至 2 0 0 2年 2月间不同类型的胫骨平台骨折 65例 ,除 10例外余均行手术治疗 ,对复杂性胫骨平台骨折者术中给T或L支撑钢板固定。结果 随访 12个月至 10年 ,平均 5 0个月 ,按Merchant评分标准 ,总不良率 2 0 % ( 1992年 10月至 1997年 10月间不良率为 2 1.9% ) ,其中复杂性、陈旧性骨折 ,内固定器械选择不当 ,固定时间过长 ,术后锻炼不当 ,伴有软组织损伤或合并髁间突骨折 ,特别是交叉韧带和软骨损伤 (经修补 )等胫骨平台骨折的不良率较高。结论 伤后手术时机的选择、骨折损伤程度和手术复位的质量是减少不良率的重要因素。尽量争取早期手术 ,术前正确判断骨折类型 (不能遗漏韧带或半月板损伤 ) ,足量植骨 。

Objective To evaluate the effect for the treatment of tibia plateau fracture and to discuss its inefficacious causes.Methods Between 1992.10 to 2002.2,65 cases were treated,and except 10 cases operations were carried out.All complex tibia plateau fractures were fixed with T or L-shaped plates.Results The follow-up lasted 12 to 108 months with an average of 50 months. Poor diagnostic rate was 20% in all cases, of which from 1992.10.to 1997.10, poor prognostic rate was 21.9%, according to Merchant's criteria. Many factors including the complexity, chronicity, the poor selection of inner fixer,time of fixation being too long,improper post-operative exercise,accompanied with soft tissue injury or complicated with the fracture of intercondular eminents,especially cross ligments and soft bone injury,etc.affected the poor prognostic rate of tibia plateau fracture.Conclusion The time of operation after injury,the degree of injury and quality of reduction of fracture are important factors affecting poor results.The key to enhance the outcome includes:to operate as soon as possible;to verdict the type of fracture;to regulate the rule of operation;to pay attention to ligment and meniscus injury;to have sufficient amount of bone implants and to make a detailed plan for performing early,loadless,functional post-operative exercise.