【摘要】 目的探讨胫骨平台骨折适宜的手术方案,比较不同内固定及植骨的临床效果。方法 112例胫骨平台骨折骨折类型按Schatzker分型,Ⅰ型10例,Ⅱ型28例,Ⅲ型39例,Ⅳ型19例,Ⅴ型11例,Ⅵ型5例。Ⅰ型患者采用闭合复位空心加压螺钉内固定,其余病例切开复位,钢板内固定,或外固定支架固定。87例有骨缺损者植骨,材料随机,其中自体植骨38例,人工骨49例。术后3个月开始部分负重, 4-5个月完全负重。结果 112例患者均获随访,平均32月,采用Rasmussen法评分,自体植骨组和人工植骨组优良率为86．8％和87．7％,无显著性差异。随着骨折严重程度的加重,优良率有下降的趋势。结论手术是治疗胫骨平台骨折的有效方法,关节面解剖复位,稳定的固定,适当的植骨,及时的关节功能康复治疗,对提高疗效有明显影响。更多还原

【Abstract】 Objectives Discuss about the surgery protocol of the fracture of tibial plateau, compare of the outcome of various operations and two kinds of bone graft. Methods Classified 112 cases of the fracture of tibial plateau, according to the system of Schatzker, as Type Ⅰ in 10 patients, Type Ⅱ in 28 patients, TypeⅢ in 39 patients, TypeⅣ in19 patients , TypeⅤ in 11 patients and TypeⅥ in 5cases. The patients of Type Ⅰ were closed reduced and fixed by cancellous screws. Others were open reduced and fixed by plates or external fixator. Bone graft was used randomly for 87 patients with bone defected , 38 of them are autograft and artifical bone are used in other 49 patients. Partial weight-bearing was permitted after 12 weeks since operation, and full weight-bearing was allowed after 16-20 weeks as the radiography indicated bone healed. Results 112 patients were followed up and assessed with the Rasmussen scale after average 32 month, the rate of excellent and good of the autograft group and artificial bone graft group is 86.8% and 87.7%, without statistical difference. There is a trend that the outcomes get worse when the fractures are more serious. Conclusions Operation is efficient to treat the fracture of tibial plateau , anatomic reduction of the articular surface, stable fixation, proper bone graft and physical therapy for rehabilitation of the joint in time can improve the outcome of treatment.更多还原