老年人胫骨平台骨折Ⅰ期全膝关节置换的研究进展  

Research progress in treatment of tibial plateau fractures with primary total knee arthroplasty in the elderly

作　　者：卜国云[1] 孙杰[1] Bu Guoyun;Sun Jie(Department of Traumatology,Tianjin Hospital,Tianjin 300222,China)

机构地区：[1]天津医院创伤科,天津300222

出　　处：《中华创伤杂志》2018年第11期1051-1056,共6页Chinese Journal of Trauma

摘　　要：胫骨平台骨折是膝关节内骨折，恢复关节面、下肢力线及良好的膝关节功能是治疗的主要目标，切开复位内固定是主要的治疗手段。老年人发生胫骨平台骨折时常伴有膝关节严重骨关节炎、骨质疏松并且骨折粉碎严重，骨折处理更为棘手，切开复位内固定有时难以达到治疗目标且术后容易产生卧床相关并发症。全膝关节置换（TKA）是治疗膝关节骨折后创伤性关节炎的主要手段，但其手术难度大、并发症多。目前已有应用Ⅰ期TKA治疗老年人胫骨平台骨折的报道，术后即刻恢复膝关节稳定，可进行早期的功能锻炼及下地负重活动，亦不需要考虑半月板保留、交叉韧带修复及复杂骨折关节面解剖复位等问题。笔者从治疗优势、手术相关问题及费用等方面就Ⅰ期TKA治疗老年人胫骨平台骨折的进展进行综述，为提高老年人胫骨平台骨折救治水平提供参考。Tibial plateau fractures are intra-articular fractures of the knee. Restoring the articular surface, axis of lower extremities and function of knee is the main goal of treatment. Open reduction and internal fixation remains the gold standard for the treatment. However, it is more difficult to treat fractures in elderly patients with severe osteoarthritis, osteoporosis, and comminuted knee joints. Open reduction and internal fixation are sometimes difficult to achieve the treatment goal, and the patients are prone to bed-related complications. Total knee arthroplasty （TKA） is the main method for the treatment of traumatic arthritis after knee fracture, but the surgery is difficult with multiple complications. At present, some authors have applied primary TKA to the tibial plateau fractures and reported the advantages including immediate post-operative knee stability, early functional exercise and weight-bearing activities, and no need to consider the meniscus retention, cruciate ligament repair and articular anatomical reduction. This article reviews the surgical advantages, surgery-related issues and expenses to discuss the treatment of tibial plateau fractures in the elderly with TKA, providing reference for the treatment of tibial plateau fractures in the elderly.

关 键 词：胫骨骨折 关节成形术 置换 膝 老年人 

分 类 号：R687.4[医药卫生—骨科学]