复杂性胫骨平台骨折的分期治疗  

Staged management of complex fractures of tibial plateau

作　　者：王洪刚[1] 顾立强[1] 朱庆棠[1] 李平[1] 秦本刚[1] 

机构地区：[1]中山大学附属第一医院显微创伤骨科,广州510080

出　　处：《中华创伤骨科杂志》2013年第11期951-955,共5页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金（81272021）

摘　　要：目的探讨分期治疗复杂性胫骨平台骨折的可行性及疗效。方法2007年12月至2011年12月采用分期治疗8例复杂性胫骨平台骨折患者，男6例，女2例；年龄30～65岁，平均49．3岁；骨折按Schatzker分型：Ⅳ型2例，V型4例，Ⅵ型2例。I期处理：8例患者均急诊手术，给予跨膝关节外固定支架固定＋骨筋膜问室切开减压，其中3例胭动脉损伤患者行大隐静脉移植修复。Ⅱ期处理：7例患者将外固定转换为内固定，行切开复位胫骨近端解剖锁定板固定；另1例患者因局部软组织条件茺，行克氏针有限内崮定联合外固定支架固定。结果所有患者的手术切口均一期愈合，无切口感染、皮缘坏死、内固定物外露等并发症发生。术后平均随访14个月（10～24个月），骨折均获骨性愈合，X线愈合时间平均为5个月（4～8个月）。本组7例患者膝关节活动度均超过90。，甲均伸膝2．6°，平均屈膝104．5°；另1例患者出现一定程度的膝关节僵硬，活动度为5。～55。。按美国特种外科医院评分系统评定疗效：优6例，良1例，可1例。结论分期治疗复杂性胫骨平台骨折足一种有效的处理方式，有利于降低其术后软组织并发症发牛率和改善其疗效。Objective To assess the feasibility of staged management of complex fractures of tihial plateau. Methods Between December 2007 and December 2011, 8 cases of complex fractures of tibial plateau were treated by staged management. Their mean age was 49.3 （range, 30 to 65） years. Fractures were classified according the Schatzker classification of tibial plateau fractures. There were 2 cases of Schatzker IV, 4 Schatzker V and 2 Sehatzker V]. At tile first stage, they were treated with bridging external fixatiml plus open decompression of the osteofascial compartment, and 3 cases of them with reconstruction of the pnpliteal artery by great saphenous vein graft. At the second stage, 7 cases underwent open reduction and definitive stabilization with an anatomic locking plate, and the other one was treated with K-wire fixation and external fixatnr. Results All operative incisions healed well without any complications like wound in- fection, skin neerosis or exposure of implants. A mean follow-up of 14 （range, 10 to 24） months revealed bony union of all fractures. The mean time for X-ray union was 5 （range, 4 to 8） months. Range of knee motion was from 2.6° to 104. 5° in 7 cases, with a mean of over 90°, but from 5° to 55° in one patient with knee stiffness. According to the HSS （Tbe Hospital for Special Surgery Score） system, 6 cases were excellent, one fine and one fair, giving a fine. Conclusion Staged nmnagement of complex fractures of tibial plateau is effective, because it can decrease soft tissue complications and improve the outcomes of treatment

关 键 词：胫骨骨折 创伤和损伤 骨折固定术 分期治疗 

分 类 号：R687.3[医药卫生—骨科学]