高能量胫骨平台骨折的处置.docVIP

高能量胫骨平台骨折的处置 作者：张德荣 杨淮海 刘红兵 殷俊 【关键词】 骨折 摘要：［目的］探讨高能量胫骨平台骨折的处置。［方法］本组对1998年1月～2003年6月收治高能量胫骨平台骨折46例的处理进行回顾性研究。［结果］43例术后随访1～4a，膝关节功能均基本恢复，据Merchant标准评分，优良率82．4％。［结论］高能量胫骨平台骨折应重视围手术期综合处理。术前对骨折的复杂程度及合并伤正确评估；术中必须考虑骨损伤和伴有软组织损害，如果不能进行完全切开复位内固定，可采取有限切开、间接复位、杂合固定，力求恢复关节功能，尽量维持正常的力轴线，确保关节稳定，术后早期密切观察患肢情况，加强膝关节早期功能锻炼，采取综合有效的对策，可使受损的膝关节功能达到最大程度恢复。 　　关键词：骨折；胫骨平台；围手术期；治疗 　　Management of highenergy fractures of tibial plateau 　　Abstract：［Objective］To investigate the treatment for highenergy fractures of tibial plateau. ［Method］Fourtysix cases of highenergy fractures of tibial plateau treated since January 1998 to June 2003 were studied retrospectively.［Results］Fortythree cases were followedup for one to four years postoperatively. Knee function recovered generally in all cases. According to Merchant classification, the satisfactory rate was 82.4 %. ［Conclusion］Perioperative management of the highenergy fractures of tibial plateau must be emphasized as following: The complications of fracture must be evaluated exactly preoperatively. During the operation, not only the bony injury but also the associated soft tissue damage should be considered. If open reduction and internal fixation couldnt be fulfilled, limited open incision, indirect reduction and hybrid fixation strived to restore joint congruity should be taken, the normal mechanical axis should be maintained to ensure knee joint stability , and to restore a full range of motion. The state of injurd limbs must be observed closely postoperatively, earlystage knee functional exercise should be started, various effective methods can be taken to recover the injured knee function to the best level if possible. 　　Key words：Tibial plateau;Fracture;Perioperation; Treatment 　　胫骨平台高能量骨折是膝关节内严重复杂骨折，并常常伴有韧带、半月板损伤及血管神经等严重的软组织损害。如何正确处理其复杂骨折及并发症，减少膝关节功能损害，避免创伤性骨关节病则显得至关重要。本科自1998年1月～2003年6月共收治这类骨折46例，取得较满意的效果，现将其报告如下： 　　1 临床资料 　　1.1 一般资料 　　本组46例，男34例，女12例，年龄21～62岁，平均38.6岁，受伤至手术时间4h～15d，平均2.3d。致伤原因：交通事故