胫骨平台骨折手术治疗及疗效分析  

Surgical treatment of tibial plateau fracture and its clinical analysis

作　　者：刘洋[1] 鲁世保[2] 李家谋[1] 麻松[1] 王宝[1] 林欣[1] 

机构地区：[1]首都医科大学北京天坛医院骨科,北京市100050 [2]北京市朝阳医院,100052

出　　处：《中华创伤骨科杂志》2005年第3期214-217,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的总结胫骨平台骨折手术治疗的临床结果,分析影响手术效果的因素。方法回顾分析2001年1月～2003年12月收治的39例胫骨平台骨折手术患者,骨折类型按Schatzker分型,Ⅰ型5例,Ⅱ型12例,Ⅲ型8例,Ⅳ型5例,Ⅴ型6例,Ⅵ型3例。Ⅰ型患者采用闭合复位空心加压螺钉内固定,Ⅲ型有3例患者在关节镜下复位植骨石膏外固定。其余病例分别采用切开复位,钢板内固定,有骨缺损者自体植骨。术后3个月开始部分负重,5个月完全负重。结果39例患者均获随访,平均时间1.8年,采用Rasmussen临床和放射评分方法,优良率分别为89.7%和87.2%。4例患者出现创伤性骨性关节炎,2例患者有严重的骨质疏松,术后出现不同程度关节面塌陷。结论手术是治疗胫骨平台骨折的有效方法,稳定的内固定,尽可能减少对骨折块的血运干扰,保护关节附属结构,正确关节功能康复治疗,对提高疗效有明显影响。Objective To review clinical outcomes of the conventional surgical treatment of tibial plateau fractures and to analyze factors affecting the clinical results. Methods 39 cases of tibial plateau fracture were treated with open reduction and internal fixation from Jan. 2001 to Dec. 2003 in our departments. According to Schatzker classification, 5 cases were of type Ⅰ, 12 type Ⅱ, 8 type Ⅲ, 5 type Ⅳ, 6 type Ⅴ, and 3 type Ⅵ. All the type Ⅰcases were treated with cannulated screws, 3 cases of type Ⅲwere treated with open reduction and bone graft under arthroscope. Other types were treated with open reduction and internal fixation with buttress plates, or with autologous bone graft in cases of bone defects. Factors affecting the clinical results were analyzed. Results All the patients were followed up for an average period of 1.8 years. The clinical results were assessed according to Rasmussen clinical and radiological scoring systems which showed the excellent and good rates were 89.7%and 87.2%respectively. 4 cases of patients got traumatic arthritis, and 2 patients with severe osteoporosis experienced articular depression. Conclusions Internal fixation is an effective method to treat tibial plateau fracture. Stable internal fixation, minimal invasion to the blood supply of fracture segments, a good protection of the knee joint structure, and correct function rehabilitation have a significant impact on curative effects.

关 键 词：胫骨平台 骨折 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]