胫骨平台骨折内固定疗效分析  被引量:68

Analysis of the Effect of the Tibial Plateau Fractures with Internal Fixation

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作  者:顾龙殿[1] 王永安[1] 瞿卫[1] 

机构地区:[1]上海市南汇区中心医院骨科,201300

出  处:《骨与关节损伤杂志》2004年第12期806-808,共3页The Journal of Bone and Joint Injury

摘  要:目的 探讨胫骨平台骨折内固定治疗的临床效果。方法 回顾性总结用单侧钢板、双侧钢板及单纯螺钉、克氏针对不同类型的胫骨平台骨折作内固定疗效。同时分析伤后手术时机、术后外固定和屈膝功能锻炼时间对膝关节功能恢复的影响。结果 本组共 186例随访 6个月~ 6年 ,总优良率为 85 5 %。伤后第一阶段 (1~ 5d)手术 ,伤口一期愈合率为 86 92 % ,伤后第二阶段 (6~ 10d)手术 ,伤口一期愈合率为 96 5 %。术后 2周内作屈膝功能锻炼者膝关节伸屈功能 90 %以上恢复 ,外固定 6周后再作屈膝功能锻炼者 2 7 5 %病例出现膝关节伸屈活动度减小。结论 单侧钢板适用于按Schectzker分类Ⅰ~Ⅳ型骨折 ,双侧钢板适用于Ⅴ~Ⅵ型骨折 ,单纯螺钉克氏针 ,可用于Ⅰ~Ⅲ型骨折 ,但稳定性差。手术时机在受伤 1周以后局部水肿消退 ,皮肤出现皱纹时为最佳。术中植骨将减少术后胫骨平台的下陷 ,并能早期屈膝及负重功能锻炼 ,促进骨折愈合及功能恢复。Objective To discuss the clinical effect of tibial flateau fractures with internal fixation.Methods The experience of treatment was retrospectively summarized using unilateral plate,double plate and simple screw,Kirschner wires to the different kinds of the tibial plateau factures.The operation chance after being injured,external fixation after operation and the knees' flexure and extending function exercise time to the affection on the recovery of knee joint function were anlysed.Results One hundred eighty six cases were followed up with average of 37.2±19.5 months(ranged from 6 months to 6 years),the excellent rate was 85.5 percent of the patients.To the first stage operation (about 1 or 5 days) after being injured,the wound healing by first intention was 86.92 percent,the second (about 6 or 10 days),the rate of wound to heal by first intention comes 96.5 percent.More than 90 percent of the patients who do the knee function exercise recovered from the knee joint flexure and extending function two weeks after operation.About 27.5 percent of the patients decreased the knee joint flexure and extending activities after external fixation 6 weeks.Conclusion Unilateral plate adapts to type Ⅰ~Ⅳ fracture in Schectzker classification,double plate to type Ⅴ~Ⅵ facture,simple screw,Kirschner wires canbe used in type Ⅰ~Ⅲ facture,but its stability is poor.The chance of operation,one week after being injured,when part of edema come to subside,or the time when the skin wrinkles appears wrinkles.The bone graft during the operation will decrease tibial plateau sinking after operation,propitious to the knees' flexure and extension and do the burden function exercise in the early time,promoting the fracture and function recovery.

关 键 词:胫骨平台骨折 功能锻炼 术后 内固定 双侧 单侧 一期愈合 促进骨折愈合 螺钉 钢板 

分 类 号:R683[医药卫生—骨科学] R681[医药卫生—外科学]

 

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