【摘要】 目的 總結(jié)復(fù)雜脛骨平臺骨折手術(shù)治療的臨床經(jīng)驗。 方法 2007年1月-2009年12月，采用切開復(fù)位內(nèi)固定治療復(fù)雜脛骨平臺骨折56例。男37例，女19例；年齡19～76歲，平均45.6歲。骨折按Schatzker分型:Ⅳ型12例，Ⅴ型26例，Ⅵ型18例。合并半月板損傷20例，膝內(nèi)側(cè)副韌帶損傷9例，外側(cè)副韌帶損傷8例，交叉韌帶損傷4例。受傷至手術(shù)時間7～14 d，平均9 d。 結(jié)果 術(shù)后53例切口Ⅰ期愈合；2例術(shù)后3 d切口出現(xiàn)淺表感染，1例術(shù)后7 d外側(cè)切口出現(xiàn)皮膚壞死、鋼板外露，均對癥處理后愈合。56例均獲隨訪，隨訪時間14～49個月，平均19個月。骨折均于術(shù)后4～8周愈合，平均6周。并發(fā)膝關(guān)節(jié)僵硬1例、創(chuàng)傷性關(guān)節(jié)炎2例、異位骨化1例，相應(yīng)處理后治愈。術(shù)后12個月按美國特種外科醫(yī)院評分標(biāo)準(zhǔn)評價療效，獲優(yōu)43例，良5例，可4例，差4例，優(yōu)良率85.7%。 結(jié)論 手術(shù)治療復(fù)雜脛骨平臺骨折需重視軟組織條件，掌握好手術(shù)時機、選擇合適內(nèi)固定、提高手術(shù)技巧、術(shù)后有效的功能鍛煉是保證療效的關(guān)鍵。
【Abstract】 Objective To summarize the clinical experiences of surgical treatment for complex tibial plateau fractures. Methods From January 2007 to December 2009, 56 patients with complex tibial plateau fractures underwent open reduction and internal fixation. The patients included 37 males and 19 females with the age of 19-76 years old (average 45.6 years old). The Schatzker type of the fractures were type Ⅳ in 12 patients, type Ⅴ in 26, and type Ⅵ in 18. The injuries included meniscus injury in 20 patients, injury of lateral collateral ligament of knee in 9, injury of lateral collateral ligament in 8, and cruciate ligaments injury in 4. The time duration between the injury and the surgery was 7-14 days (average 9 days). Results After the surgery, the incision healed at I stage in 53 patients. The incision was superficially infected 3 days after surgery in 2 patients, and the Necrosis of skin around the incision and revealed steel plate were found 7 days after surgery in 1 patient; the injuries was healed after corresponding treatment. All of the patients were followed up with the average follow-up period of 14-49 months (average 19 months). The fractures healed 4-8 weeks (average 6 weeks) after the surgery. Knee joint ankylosis was found in one, traumatic arthritis was found in two, and heterotopic ossification was found in one; the injuries was healed after corresponding treatment. Twelve months after the surgery, the therapeutic effect according to HSS criteria indicated that the score was excellent in 43, good in 5, generally in 4 and poor in 4; with a fine rate of 85.7%. Conclusion Appropriate conditions of the soft tissue, good surgical opportunity, a appropriate fixation, improved surgical technique and effective postoperative functional training are the key points of surgical treatment for complex tibial plateau fractures.
引用本文： 林真富,羅偉,謝懷春,李霖,馮彥哲. 復(fù)雜脛骨平臺骨折手術(shù)治療分析. 華西醫(yī)學(xué), 2011, 26(10): 1511-1513. doi: 復(fù)制
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| 7. | Barei DP, Nork SE, Mills WJ, et al. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incisiontechnique[J]. J Orthop Trauma, 2004, 18(10): 649-657. |
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- 2. 劉云鵬, 劉沂. 骨與關(guān)節(jié)損傷和疼病的診斷分類及功能評定標(biāo)準(zhǔn)[M]. 北京: 清華大學(xué)出版社, 2002: 233-234.
- 3. 陸晴友, 彭莊, 席秉勇. 脛骨平臺骨折術(shù)中下肢力線的恢復(fù)與療效分析[J]. 中國矯形外科雜志, 2008, 16(4): 256-259.
- 4. Georgiadis GM. Combined anterrior and posterior approaches for complex tibial plateau fractures[J]. J Bone Joint Surg (Br), 1994, 76(2): 285-289.
- 5. 羅從風(fēng), 陳云豐, 高洪, 等. 改良雙鋼板法治療復(fù)雜脛骨平臺骨折[J]. 中華骨科雜志, 2004, 26(6): 326-329.
- 6. 費俊梁, 王黎明, 桂鑒超, 等. 有限切開內(nèi)固定結(jié)合組合式外固定器治療復(fù)雜脛骨平臺骨折[J]. 中國骨與關(guān)節(jié)損傷雜志, 2008, 23(4): 324-325.
- 7. Barei DP, Nork SE, Mills WJ, et al. Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two-incisiontechnique[J]. J Orthop Trauma, 2004, 18(10): 649-657.