复杂胫骨平台骨折术后疗效不佳原因分析_临床医学论文.docVIP

复杂胫骨平台骨折术后疗效不佳原因分析_临床医学论文 复杂胫骨平台骨折术后疗效不佳原因分析_临床医学论文 【摘要】 　　［目的］ 回顾分析复杂胫骨平台骨折术后疗效不佳的原因，提出相应的避免方法。 ［方法］ 1999年8月—2005年9月治疗的62例SchatzkerⅣ—Ⅵ型骨折中，根据Rasmussen膝关节功能评分标准，对评判术后疗效为可和差的21例进行综合分析。21例均采用手术治疗，伤后到手术的平均时间为4（1~12d），18例采用切开复位钢板内固定，其中5例运用自体髂骨移植；3例采用闭合撬拨中空螺钉固定。［结果］ 评为可的18例中，SchatzkerⅣ 11例，Ⅴ 4例，Ⅵ 3例；差的3例中Ⅳ—Ⅵ型各占1例，术后伴有切口裂开、感染或切口皮肤坏死。随访时间平均33个月（6~72个月），主要出现膝关节疼痛，内外翻，膝关节伸屈活动受限等。［结论］影响复杂胫骨平台骨折术后疗效的因素有骨折分型与治疗方案不一致、关节功能锻炼不及时、手术时机不当、关节面复位的质量与术者的心理因素等。 【关键词】 胫骨平台骨折 内固定器 疗效 原因 分析 　　Abstract:［Objective］ To analyze prognostic relative factors in treatment by evaluating the surgical results of complex tibial plateau fracture retrospectively and provide corresponding suggestions .［Methods］ 62 cases with complex tibial plateau fracture were treated operatively between Aug. 1999 and Sep. 2005.Among them,21 cases were found with unsatisfied results due to pain,deformity and limitation of flexion-extension function. According to the Schatzker classification, there were type Ⅳ fracture in 12 cases, type Ⅴfracture in 5 cases and type Ⅵ fracture in 4 cases. Of 21cases,there were 13 males and 8 females,the average age was 382 years (range, 21 to 63 years).The mechanisms of injury were traffic accident in 14 cases, tumble in 6 cases and fall in 1 case.21 cases which were all close fracture were operated with an average interval of 48 days from injury to surgery(range, 1 to 12 days).During operation,18 cases were treated with open reduction and internal fixation with plates,of 5 cases were treated with grafting autologous iliac bone; and 3 cases were treated with prying reduction and internal fixation with screws. ［Results］ The average period of follow-up was 33were type Ⅳ fracture,4 cases type Ⅴ fracture and 3 cases type Ⅵ fracture; poor in 3 cases,1 case of which was type Ⅳ fracture,1 case type Ⅴ fracture and 1 case type Ⅵ fracture.Complications included wound dehiscence in 4 cases,2 of which were skin necrosis of incision;infection in 2 cases.The 21 cases were suffered from posttraumatic